Studying the Relationship of Practice Guideline Adherences of Antibiotic Prescriptions and Treatment Outcomes - Using Therapeutic Antibiotics of Pneumonia and Prophylactic Antibiotics in Surgery as Examples
Date Issued
2012
Date
2012
Author(s)
Hsu, Chen-Tong
Abstract
Background: The overgrowing usage of antibiotics with the problem of increasing drug-resistant bacteria has been a significant global health issue, while the same serious condition exists in our society. How to regulate the rational use of antibiotics has become an important theme in the aspects of clinical care and quality of healthcare. Through the intervention of evidence-based clinical practice guidelines has been recommended as an effective strategy; however, it is in lack of adequate research and evaluation about the actual adherences to clinical guidelines and the associations between clinical guidelines and treatment outcomes, so there is a need for further exploration.
Purposes: First, understand the current status of antibiotic usage and the trend of guideline adherences in our society. Second, analyze the explanatory factors of adhering antibiotic clinical guidelines. Third, study the associations of antibiotic guideline adherences and treatment outcomes. Fourth, evaluate the relationship between antibiotic guideline adherences and medical expenses.
Methods: Choose the ‘guidelines on antimicrobial therapy of pneumonia in Taiwan’ (1999 & 2006) and the ‘guidelines for the use of prophylactic antibiotic in surgery in Taiwan’ (2004) as targets. Use 12-year (1998 to 2009) claim data from the ‘Longitudinal Health Insurance Database 2005’ and special application data of National Health Insurance. Joinpoint regression was used to define whether it is statistically significant in the degree of trend of guideline adherences during 1998 to 2009, and generalized estimating equations for multivariate logistic regression analysis to examine the explanatory factors of adhering clinical guidelines, as well as the relationship between clinical guidelines and treatment outcomes and medical expenses.
Results: First, the antibiotic guideline adherences during the study period showed a gradually upward trend, but there were significantly different degrees of trend among different diseases and types of surgery. Second, in the case of controlling patients'' characteristics, antibiotic guideline adherences were associated with different physicians’ characteristics and hospitals’ characteristics. Third, antibiotic guideline adherences for community-acquired pneumonia in ambulatory departments could decrease the possibility of hospitalization by the pneumonia-related diagnosis within 7 days after the visit, and adherence to prophylactic antibiotic guidelines in surgery could reduce the readmission rate within thirty days after discharge and lessened the length of hospitalization. Fourth, antibiotic guideline adherences were negatively correlated with medical expenses, i.e. the higher the guideline adherences the less the healthcare costs.
Conclusion: Antibiotic guideline adherence is a useful quality indicator in the aspect of process. It is not only easy to measure and can be operated by using administrative claims data, but it shows a high degree of correlation with the medical outcomes.
Subjects
clinical guideline adherence
therapeutic antibiotics of pneumonia
prophylactic antibiotics in surgery
treatment outcome
quality of healthcare
Type
thesis
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