Intended for healthcare professionals

  1. Research
  2. Effect of a...
  3. Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomised controlled trial
Primary Care

Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomised controlled trial

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.38602.586343.55 (Published 22 September 2005) Cite this as: BMJ 2005;331:669
  1. Mark Loeb, associate professor (loebm{at}mcmaster.ca)1,
  2. Kevin Brazil, associate professor2,
  3. Lynne Lohfeld, associate professor2,
  4. Allison McGeer, professor3,
  5. Andrew Simor, professor4,
  6. Kurt Stevenson, medical director5,
  7. Dick Zoutman, associate professor6,
  8. Stephanie Smith, research coordinator1,
  9. Xiwu Liu, graduate student2,
  10. Stephen D Walter, professor2
  1. 1 Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
  2. 2 Department of Clinical Epidemiology and Biostatistics, McMaster University
  3. 3 Department of Microbiology, Toronto Medical Laboratories, University of Toronto, Toronto, ON, Canada
  4. 4 Department of Microbiology, Sunnybrook and Women's College Health Sciences Centre, Toronto, ON, Canada
  5. 5 Qualis Health, Boise, Idaho, USA
  6. 6 Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
  1. Correspondence to: M Loeb
  • Accepted 1 August 2005

Abstract

Objective To assess whether a multifaceted intervention can reduce the number of prescriptions for antimicrobials for suspected urinary tract infections in residents of nursing homes.

Design Cluster randomised controlled trial.

Setting 24 nursing homes in Ontario, Canada, and Idaho, United States.

Participants 12 nursing homes allocated to a multifaceted intervention and 12 allocated to usual care. Outcomes were measured in 4217 residents.

Interventions Diagnostic and treatment algorithm for urinary tract infections implemented at the nursing home level using a multifaceted approach—small group interactive sessions for nurses, videotapes, written material, outreach visits, and one on one interviews with physicians.

Main outcome measures Number of antimicrobials prescribed for suspected urinary tract infections, total use of antimicrobials, admissions to hospital, and deaths.

Results Fewer courses of antimicrobials for suspected urinary tract infections per 1000 resident days were prescribed in the intervention nursing homes than in the usual care homes (1.17 v 1.59 courses; weighted mean difference −0.49, 95% confidence intervals −0.93 to −0.06). Antimicrobials for suspected urinary tract infection represented 28.4% of all courses of drugs prescribed in the intervention nursing homes compared with 38.6% prescribed in the usual care homes (weighted mean difference −9.6%, −16.9% to −2.4%). The difference in total antimicrobial use per 1000 resident days between intervention and usual care groups was not significantly different (3.52 v 3.93; weighted mean difference −0.37, −1.17 to 0.44). No significant difference was found in admissions to hospital or mortality between the study arms.

Conclusion A multifaceted intervention using algorithms can reduce the number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes.

Footnotes

  • Contributors ML, KB, LL, AM, AS, and SDW contributed to the study design. ML, SS, KS, and DZ conducted the study. SDW, ML, and XL contributed to the analysis. All authors interpreted the data and revised the manuscript. ML drafted the manuscript; he is guarantor.

  • Funding This study was funded by the Agency for Healthcare Research and Quality as part of the Translating Research into Practise initiative. The authors work was independent of the funding agency. ML is supported by the Canadian Institute of Health Research. SDW is a senior investigator with the Canadian Institute of Health Research.

  • Competing interests None declared.

  • Ethical approval This study was approved by the McMaster University ethics committee and the medical advisory committees or resident councils of the nursing homes.

  • Accepted 1 August 2005
View Full Text
Back to top