Clinical trial NCT03173768: Appropriateness of Intravenous Antibiotics Prescriptions at Hospital Discharge
Official title: Quasi-experimental Study Comparing Intravenous Antibiotics Prescriptions at Hospital Discharge With and Without ID Consultation
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Anti-Infectives Adverse Reaction
Keywords: intravenous antibiotics
appropriateness
outpatient antimicrobial therapy
Lead sponsor: Chiang Mai University
Sponsor class: OTHER
First posted: 2017-06-02
Enrollment: 173
Sex: ALL
Minimum age (years): 15
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: SEQUENTIAL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: A quasi-experimental study was conducted among patients receiving care at the medicine units of the Maharaj Nakorn Chiang Mai Hospital to determine the appropriateness of intravenous antibiotics at hospital discharge with and without ID consultation.

Detailed description: The pre-intervention period was started from November 1, 2015 to April 30, 2016 (6-month period), in which the intravenous antibiotics at hospital discharge were prescribed by the primary care team. The post-intervention period was started from May 1, 2016 to February 28, 2017 (10-month period), in which the intravenous antibiotics at hospital discharge were reviewed and intervened by ID team.

The appropriateness of intravenous antibiotics was assessed separately by the ID fellow and ID specialist. If disagreement occurred, the feedback to the ID fellow was performed and the decision by ID specialist was used in the final analysis of appropriateness.

In post-intervention period, ID fellow modified the intravenous antibiotics ordered by the primary team if those intravenous antibiotics were judged as inappropriate by ID fellow as follows: 1) discontinue intravenous antibiotics (treatment was complete), 2) switch to oral antibiotics, 3) change intravenous antibiotics to cover isolated pathogens, 4) adjust the dose of intravenous antibiotics, and 5) change the duration of intravenous antibiotics

Finally, ID specialist retrospectively assessed the appropriateness of intravenous antibiotics at hospital discharge managed by ID fellow in post-intervention period.

Eligibility criteria: Inclusion Criteria:

All adult patients who met the following criteria were consecutively enrolled;

1. age≥ 15 years old and
2. had infections at any sites and received intravenous antibiotics.

Exclusion Criteria:

- They were evaluated by infectious diseases specialist for appropriate antibiotics during admission

Primary outcomes:
measure: The proportion of appropriateness of intravenous antibiotics prescriptions at hospital discharge between groups
timeFrame: 16 months
Secondary outcomes:
measure: The costs of antibiotics for the course of treatment
timeFrame: 16 months
measure: Clinical improvement at 1 week
timeFrame: 1 week
measure: Readmission within 30 days, length of hospital stay
timeFrame: 30 days
measure: Length of hospital stay
timeFrame: 60 days
Other outcomes:
Locations:
city: Chiang Mai
country: Thailand
facility: Department of Medicine
Study officials:
affiliation: Maharaj Nakorn Chiang Mai Hospital
name: Romanee Chaiwarith, MD
role: PRINCIPAL_INVESTIGATOR
References: