The impact of policy guidelines on hospital antibiotic use over a decade: a segmented time series analysis.
Antibiotic pressure contributes to rising antibiotic resistance. Policy guidelines encourage rational prescribing behavior, but effectiveness in containing antibiotic use needs further assessment. This study therefore assessed the patterns of antibiotic use over a decade and analyzed the impact of d...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2014-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3960230?pdf=render |
| _version_ | 1818987240488960000 |
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| author | Sujith J Chandy Girish S Naik Reni Charles Visalakshi Jeyaseelan Elena N Naumova Kurien Thomas Cecilia Stalsby Lundborg |
| author_facet | Sujith J Chandy Girish S Naik Reni Charles Visalakshi Jeyaseelan Elena N Naumova Kurien Thomas Cecilia Stalsby Lundborg |
| author_sort | Sujith J Chandy |
| collection | DOAJ |
| description | Antibiotic pressure contributes to rising antibiotic resistance. Policy guidelines encourage rational prescribing behavior, but effectiveness in containing antibiotic use needs further assessment. This study therefore assessed the patterns of antibiotic use over a decade and analyzed the impact of different modes of guideline development and dissemination on inpatient antibiotic use.Antibiotic use was calculated monthly as defined daily doses (DDD) per 100 bed days for nine antibiotic groups and overall. This time series compared trends in antibiotic use in five adjacent time periods identified as 'Segments,' divided based on differing modes of guideline development and implementation: Segment 1--Baseline prior to antibiotic guidelines development; Segment 2--During preparation of guidelines and booklet dissemination; Segment 3--Dormant period with no guidelines dissemination; Segment 4--Booklet dissemination of revised guidelines; Segment 5--Booklet dissemination of revised guidelines with intranet access. Regression analysis adapted for segmented time series and adjusted for seasonality assessed changes in antibiotic use trend.Overall antibiotic use increased at a monthly rate of 0.95 (SE = 0.18), 0.21 (SE = 0.08) and 0.31 (SE = 0.06) for Segments 1, 2 and 3, stabilized in Segment 4 (0.05; SE = 0.10) and declined in Segment 5 (-0.37; SE = 0.11). Segments 1, 2 and 4 exhibited seasonal fluctuations. Pairwise segmented regression adjusted for seasonality revealed a significant drop in monthly antibiotic use of 0.401 (SE = 0.089; p<0.001) for Segment 5 compared to Segment 4. Most antibiotic groups showed similar trends to overall use.Use of overall and specific antibiotic groups showed varied patterns and seasonal fluctuations. Containment of rising overall antibiotic use was possible during periods of active guideline dissemination. Wider access through intranet facilitated significant decline in use. Stakeholders and policy makers are urged to develop guidelines, ensure active dissemination and enable accessibility through computer networks to contain antibiotic use and decrease antibiotic pressure. |
| first_indexed | 2024-12-20T19:03:33Z |
| format | Article |
| id | doaj.art-6a3629dc2afa4bb4aac30a766dce83f3 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-20T19:03:33Z |
| publishDate | 2014-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-6a3629dc2afa4bb4aac30a766dce83f32022-12-21T19:29:19ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-0193e9220610.1371/journal.pone.0092206The impact of policy guidelines on hospital antibiotic use over a decade: a segmented time series analysis.Sujith J ChandyGirish S NaikReni CharlesVisalakshi JeyaseelanElena N NaumovaKurien ThomasCecilia Stalsby LundborgAntibiotic pressure contributes to rising antibiotic resistance. Policy guidelines encourage rational prescribing behavior, but effectiveness in containing antibiotic use needs further assessment. This study therefore assessed the patterns of antibiotic use over a decade and analyzed the impact of different modes of guideline development and dissemination on inpatient antibiotic use.Antibiotic use was calculated monthly as defined daily doses (DDD) per 100 bed days for nine antibiotic groups and overall. This time series compared trends in antibiotic use in five adjacent time periods identified as 'Segments,' divided based on differing modes of guideline development and implementation: Segment 1--Baseline prior to antibiotic guidelines development; Segment 2--During preparation of guidelines and booklet dissemination; Segment 3--Dormant period with no guidelines dissemination; Segment 4--Booklet dissemination of revised guidelines; Segment 5--Booklet dissemination of revised guidelines with intranet access. Regression analysis adapted for segmented time series and adjusted for seasonality assessed changes in antibiotic use trend.Overall antibiotic use increased at a monthly rate of 0.95 (SE = 0.18), 0.21 (SE = 0.08) and 0.31 (SE = 0.06) for Segments 1, 2 and 3, stabilized in Segment 4 (0.05; SE = 0.10) and declined in Segment 5 (-0.37; SE = 0.11). Segments 1, 2 and 4 exhibited seasonal fluctuations. Pairwise segmented regression adjusted for seasonality revealed a significant drop in monthly antibiotic use of 0.401 (SE = 0.089; p<0.001) for Segment 5 compared to Segment 4. Most antibiotic groups showed similar trends to overall use.Use of overall and specific antibiotic groups showed varied patterns and seasonal fluctuations. Containment of rising overall antibiotic use was possible during periods of active guideline dissemination. Wider access through intranet facilitated significant decline in use. Stakeholders and policy makers are urged to develop guidelines, ensure active dissemination and enable accessibility through computer networks to contain antibiotic use and decrease antibiotic pressure.http://europepmc.org/articles/PMC3960230?pdf=render |
| spellingShingle | Sujith J Chandy Girish S Naik Reni Charles Visalakshi Jeyaseelan Elena N Naumova Kurien Thomas Cecilia Stalsby Lundborg The impact of policy guidelines on hospital antibiotic use over a decade: a segmented time series analysis. PLoS ONE |
| title | The impact of policy guidelines on hospital antibiotic use over a decade: a segmented time series analysis. |
| title_full | The impact of policy guidelines on hospital antibiotic use over a decade: a segmented time series analysis. |
| title_fullStr | The impact of policy guidelines on hospital antibiotic use over a decade: a segmented time series analysis. |
| title_full_unstemmed | The impact of policy guidelines on hospital antibiotic use over a decade: a segmented time series analysis. |
| title_short | The impact of policy guidelines on hospital antibiotic use over a decade: a segmented time series analysis. |
| title_sort | impact of policy guidelines on hospital antibiotic use over a decade a segmented time series analysis |
| url | http://europepmc.org/articles/PMC3960230?pdf=render |
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