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Multicentre evaluation of prescribing concurrence with anti-infective guidelines: epidemiological assessment of
Roel Fijn1, Man-Chie Chow, Pauline M H Schuur
1Groningen University Institute for Drug Exploration (GUIDE), University of Groningen, Division of Pharmacoepidemiology and Drug Policy, Groningen, The Netherlands. R.Fijn@Farm.RUG.nl
Purpose:
To assess indicators for anti-infective prescribing not concurrent with regional pharmacotherapeutic treatment guidelines (PTGs) on infectious diseases.
Methods:
A retrospective explorative cohort study based on hospital-wide anti-infective prescription data of a 2-month cross-sectional period (n = 1037). Risk rates (absolute risks: AR), risk rate ratios (relative risks: RR) and odds ratios (OR) with 95% confidence intervals (95%CI) were estimated for patient, disease, drug, and prescriber variables considered to be potential indicators. Univariable and multivariable logistic regression analyses were performed.
Findings:
Non-concurrence existed of non-indicated prescribing of (particular) anti-infectives (24.3%) and prescribing of non-first choice anti-infectives (55.2%). Non-concurrent durations of treatment and dosing issues accounted for 17.2% and 16.2% respectively. Non-concurrence was associated with empirical therapy, with certain diagnoses, such as skin and soft tissue, urinary, and osteoarthrological infections, and with prescriptions involving topical dosage forms, cephalosporins, macrolides and lincosamides, and quinolones. There was also an association with certain hospitals and with prescribing by geriatricians, surgeons, pulmonologists, and urologists and, in general, junior clinicians in training.
Conclusions:
Other hospitals could use our epidemiological framework to identify their own indicators for non-concurrent prescribing. Our findings suggest tailor-made enforcement of PTG adherence for certain prescribers while conversely, adaptation of the PTGs will be required for some infectious diseases.