Accepted for/Published in: JMIR Research Protocols
Date Submitted: Jun 30, 2023
Date Accepted: Jan 29, 2024
N-of-1 trials of antimicrobial stewardship interventions to optimise antibiotic prescribing for upper respiratory tract infection in emergency departments: Protocol for a quasi-experimental study
ABSTRACT
Background:
Antimicrobial stewardship programs attempting to optimise antibiotic therapy and clinical outcomes mainly focus on inpatient and outpatient settings. The lack of antimicrobial stewardship program studies in the emergency department (ED)represents a gap in tackling the problem of antimicrobial resistance as the emergency department attends to a substantial number of upper respiratory tract infection cases throughout the year.
Objective:
We intend to implement two evidence-based interventions—1) patient education; and 2) providing physician feedback on their prescribing rates—by incorporating evidence from a literature review and contextualising them based on findings from a local qualitative study.
Methods:
Our study employs a quasi-experimental design to evaluate the effects of interventions over time in the emergency departments of four public hospitals in Singapore. We will include an initial control period of 18 months. In the next six months, we will randomise two emergency departments to receive one intervention (i.e., Patient education) and the other two emergency departments to receive the alternative intervention (i.e., Physician Feedback). All emergency departments will receive the second intervention in the subsequent six months on top of the ongoing intervention. Data will be collected for another six months to assess the persistence of the intervention effects. The information leaflets will be handed to patients at the emergency departments before they consult with the physician, while feedback to individual physicians by senior doctors is in the form of electronic text messages. The feedback will contain the physicians’ antibiotic prescribing rate compared with the departments’ overall antibiotic prescribing rate and a bite-size message on good antibiotic prescribing practices.
Results:
We will analyse the data using segmented regression with difference-in-difference estimation to account for concurrent cluster comparisons.
Conclusions:
Our proposed study assesses the effectiveness of evidence-based, context-specific interventions to optimize antibiotic prescribing in EDs. These interventions are aligned with Singapore’s national effort to tackle AMR and can be scaled up if successful. Clinical Trial: NCT05451836
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