Implementation of a Cellulitis Management Plan in Three Australian Regional Health Services to Address an Evidence–Practice Gap in Antibiotic Prescribing
Despite the availability of evidence-based guidelines, antibiotics for cellulitis remain inappropriately prescribed. This evidence–practice gap is more evident in low-resource settings, such as rural hospitals. This implementation study developed and introduced a cellulitis management plan to improv...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-10-01
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| Series: | Antibiotics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2079-6382/10/11/1288 |
| _version_ | 1797511496534589440 |
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| author | Jaclyn Bishop Mark Jones James Farquharson Kathrine Summerhayes Roxanne Tucker Mary Smith Raquel Cowan N. Deborah Friedman Thomas Schulz David Kong Kirsty Buising |
| author_facet | Jaclyn Bishop Mark Jones James Farquharson Kathrine Summerhayes Roxanne Tucker Mary Smith Raquel Cowan N. Deborah Friedman Thomas Schulz David Kong Kirsty Buising |
| author_sort | Jaclyn Bishop |
| collection | DOAJ |
| description | Despite the availability of evidence-based guidelines, antibiotics for cellulitis remain inappropriately prescribed. This evidence–practice gap is more evident in low-resource settings, such as rural hospitals. This implementation study developed and introduced a cellulitis management plan to improve antibiotic prescribing for cellulitis in three health services in regional Australia. Appropriateness of antibiotic prescribing for cellulitis at Day 1 was the primary outcome measure. Adults with ICD-10-AM codes for lower-limb cellulitis admitted as inpatients of the three health services between May and November 2019 (baseline, <i>n</i> = 165) and March and October 2020 (post-implementation, <i>n</i> = 127) were included in the assessment. The uptake of the cellulitis management plan was 29.1% (37/127). The appropriateness of antibiotic prescribing for cellulitis at Day 1 was similar at baseline (78.7%, 144/183) and in the intention-to-treat post-implementation group (81.8%, 126/154) [95% CI −5.6% to 11.3%, <i>p</i> = 0.50]. Commencement of the cellulitis management plan resulted in a non-statistically significant increase in antibiotic appropriateness at Day 1 compared to when a cellulitis management plan was not commenced (88.1% vs. 79.5%; 95% CI −5.6% to 19.8%; <i>p</i> = 0.20) Evaluation of more real-world strategies to address evidence–practice gaps, such as the appropriateness of antibiotic prescribing for cellulitis, is required. |
| first_indexed | 2024-03-10T05:46:08Z |
| format | Article |
| id | doaj.art-676e06fb12d64a7a9cc90bbc701ecf99 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-10T05:46:08Z |
| publishDate | 2021-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-676e06fb12d64a7a9cc90bbc701ecf992023-11-22T22:09:22ZengMDPI AGAntibiotics2079-63822021-10-011011128810.3390/antibiotics10111288Implementation of a Cellulitis Management Plan in Three Australian Regional Health Services to Address an Evidence–Practice Gap in Antibiotic PrescribingJaclyn Bishop0Mark Jones1James Farquharson2Kathrine Summerhayes3Roxanne Tucker4Mary Smith5Raquel Cowan6N. Deborah Friedman7Thomas Schulz8David Kong9Kirsty Buising10National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity, The University of Melbourne, Level 5, 792 Elizabeth Street, Melbourne, VIC 3000, AustraliaPharmacy Department, Ballarat Health Services, Drummond Street North, Ballarat, VIC 3350, AustraliaPharmacy Department, Colac Area Health, Connor Street, Colac, VIC 3250, AustraliaClinical Improvement, Risk and Innovation, Wimmera Health Care Group, Baillie Street, Horsham, VIC 3400, AustraliaClinical Improvement, Risk and Innovation, Wimmera Health Care Group, Baillie Street, Horsham, VIC 3400, AustraliaDepartment of Health and Human Services (Victoria), McLachlan Street, Horsham, VIC 3000, AustraliaDepartment of Internal Medicine, Ballarat Health Services, Drummond Street North, Ballarat, VIC 3350, AustraliaDepartment of Infectious Diseases, Barwon Health, Ryrie Street, Geelong, VIC 3220, AustraliaNational Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity, The University of Melbourne, Level 5, 792 Elizabeth Street, Melbourne, VIC 3000, AustraliaNational Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity, The University of Melbourne, Level 5, 792 Elizabeth Street, Melbourne, VIC 3000, AustraliaNational Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity, The University of Melbourne, Level 5, 792 Elizabeth Street, Melbourne, VIC 3000, AustraliaDespite the availability of evidence-based guidelines, antibiotics for cellulitis remain inappropriately prescribed. This evidence–practice gap is more evident in low-resource settings, such as rural hospitals. This implementation study developed and introduced a cellulitis management plan to improve antibiotic prescribing for cellulitis in three health services in regional Australia. Appropriateness of antibiotic prescribing for cellulitis at Day 1 was the primary outcome measure. Adults with ICD-10-AM codes for lower-limb cellulitis admitted as inpatients of the three health services between May and November 2019 (baseline, <i>n</i> = 165) and March and October 2020 (post-implementation, <i>n</i> = 127) were included in the assessment. The uptake of the cellulitis management plan was 29.1% (37/127). The appropriateness of antibiotic prescribing for cellulitis at Day 1 was similar at baseline (78.7%, 144/183) and in the intention-to-treat post-implementation group (81.8%, 126/154) [95% CI −5.6% to 11.3%, <i>p</i> = 0.50]. Commencement of the cellulitis management plan resulted in a non-statistically significant increase in antibiotic appropriateness at Day 1 compared to when a cellulitis management plan was not commenced (88.1% vs. 79.5%; 95% CI −5.6% to 19.8%; <i>p</i> = 0.20) Evaluation of more real-world strategies to address evidence–practice gaps, such as the appropriateness of antibiotic prescribing for cellulitis, is required.https://www.mdpi.com/2079-6382/10/11/1288cellulitisantibioticstewardshipappropriatenessrural |
| spellingShingle | Jaclyn Bishop Mark Jones James Farquharson Kathrine Summerhayes Roxanne Tucker Mary Smith Raquel Cowan N. Deborah Friedman Thomas Schulz David Kong Kirsty Buising Implementation of a Cellulitis Management Plan in Three Australian Regional Health Services to Address an Evidence–Practice Gap in Antibiotic Prescribing Antibiotics cellulitis antibiotic stewardship appropriateness rural |
| title | Implementation of a Cellulitis Management Plan in Three Australian Regional Health Services to Address an Evidence–Practice Gap in Antibiotic Prescribing |
| title_full | Implementation of a Cellulitis Management Plan in Three Australian Regional Health Services to Address an Evidence–Practice Gap in Antibiotic Prescribing |
| title_fullStr | Implementation of a Cellulitis Management Plan in Three Australian Regional Health Services to Address an Evidence–Practice Gap in Antibiotic Prescribing |
| title_full_unstemmed | Implementation of a Cellulitis Management Plan in Three Australian Regional Health Services to Address an Evidence–Practice Gap in Antibiotic Prescribing |
| title_short | Implementation of a Cellulitis Management Plan in Three Australian Regional Health Services to Address an Evidence–Practice Gap in Antibiotic Prescribing |
| title_sort | implementation of a cellulitis management plan in three australian regional health services to address an evidence practice gap in antibiotic prescribing |
| topic | cellulitis antibiotic stewardship appropriateness rural |
| url | https://www.mdpi.com/2079-6382/10/11/1288 |
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