抗生物質の不適切な処方に対する行動介入の効果: ランダム化臨床試験
Daniella Meeker1, Jeffrey A Linder2, Craig R Fox3
1Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles2RAND Corporation, Santa Monica, California.
JAMA
|February 12, 2016
まとめ
責任ある正当化や 同級生比較のような行動介入は,急性呼吸器感染症の不適切な抗生物質の処方量を 顕著に減少させた. これらの戦略は 抗生物質管理を改善するための効果的な方法を提供します
科学分野:
- 行動科学
- 感染症 管理
- 主要治療薬
背景:
- 急性呼吸器感染症 (ARTIs) に対する不適切な抗生物質の処方は,依然として重大な公衆衛生上の懸念事項です.
- 行動科学の原則は 臨床医の処方習慣を 修正するための潜在的戦略を提供します
研究 の 目的:
- 行動介入の有効性を評価し,AMTIの不適切な処方量を削減する.
- 特定の介入の影響を評価する:提案された代替案,説明責任の正当化,ピア比較.
主な方法:
- 47人の初等医療従事者と248人の臨床医を対象としたクラスターランダム化臨床試験です.
- 臨床医はランダムに分けられ,18ヶ月間にわたって0,1,2,または3つの行動介入を受けました.
- ARTの抗生物質処方率に関するデータを収集し,同時に発生する介入と介入前の傾向に分析を調整した.
主要な成果:
- 責任ある正当化とピア比較の介入により 不適切な抗生物質の処方率が大幅に減少しました
- 責任ある正当化介入は -7.0%の差異を示した (P < .001).
- 同級生との比較介入は,差異の - 5. 2% (P < . 001) を示した.
結論:
- 行動介入,特に説明責任の正当化とピア比較は,ARTIの不適切な抗生物質の処方量を減らすのに有効です.
- これらの発見は,抗生物質管理を強化するために,電子医療記録と実践レベルのフィードバックに行動戦略を統合することを支持しています.
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