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Reducing Prolonged Antibiotic Use Among Nursing Home Residents
According to a recent study, peer comparison audits and feedbacks are a pragmatic intervention that can help reduce the use of antibiotics for longer durations among residents in long-term care (LTC) facilities. The researchers suggested that these smaller reductions can “translate to large reductions in antibiotic days of treatment across populations.”
The authors of the study explained that overprescribing of antibiotics in LTC settings is often due to prescriber preferences. The noted that it is also linked with preventable harms for residents.
For the study, 1238 physicians caring for 96,185 residents were included. Of these participants, 895 (72%) physicians received no feedback, and 343 (28%) were enrolled to receive audit and feedback and were randomized 1:1 to static or dynamic reports.
“Among all residents, between the first quarter of 2018 and last quarter of 2019, there were temporal declines in antibiotic initiation (28.4% to 21.3%) and prolonged duration (34.4% to 29.0%),” the authors explained. “Difference-in-differences analysis confirmed that feedback was associated with a greater decline in prolonged antibiotics (adjusted difference -2.65%, 95% confidence interval [CI]: -4.93 to -.28%, P=.026), but there was no significant difference in antibiotic initiation.”
Of important note, reduced antibiotic durations were linked with 335,912 fewer days of treatment. Furthermore, the researchers reported that the embedded RCT found no differences in outcomes among the dynamic and static reports.
“Peer comparison audit and feedback is a pragmatic intervention that can generate small relative reductions in the use of antibiotics for prolonged durations that translate to large reductions in antibiotic days of treatment across populations,” the authors concluded.
Reference:
Daneman N, Lee SM, Bai H, et al. Population-Wide Peer Comparison Audit and Feedback to Reduce Antibiotic Initiation and Duration in Long-Term Care Facilities with Embedded Randomized Controlled Trial. Clin Infect Dis. 2021;73(6):e1296-e1304. doi:10.1093/cid/ciab256
