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J Avorn

Publications and source records attributed to J Avorn.

170 records · Page 10Linked to original sources
PubMedDate not supplied

Academic detailing to improve use of broad-spectrum antibiotics at an academic medical center.

BACKGROUND: Antibiotic misuse is common and costly and may promote antibiotic resistance. We tested the efficacy of a targeted one-on-one educational program ("academic detailing") designed to improve the appropriateness of broad-spectrum antibiotic use. METHODS: A randomized controlled trial was conducted in a large US teaching hospital. During an 18-week study period, 17 general medical, oncology, and cardiology services either received academic detailing or did not. The intervention was prompted by an order for either levofloxacin or ceftazidime that led to a computer-based review of data for that patient. Orders for the 2 target antibiotics deemed unnecessary by a priori criteria were included in the study. The primary outcome examined was the number of days that unnecessary levofloxacin or ceftazidime was administered in intervention and control groups. RESULTS: Before the trial, intervention and control services had similar prescribing patterns for the target antibiotics; the drugs were used for similar indications throughout the study period. During the intervention, there was a reduction of 37% in days of unnecessary levofloxacin or ceftazidime use per 2-week interval on services randomized to the educational intervention vs control services (P< .001). In multivariable analyses controlling for baseline prescribing and study interval, the rate of unnecessary use of the 2 target antibiotics was reduced by 41% on the intervention services compared with controls (95% confidence interval, 44%-78%; P< .001). Length of stay, intensive care unit transfers, readmission rates, and in-hospital death rates were similar in both groups (P> or =.10 for all). CONCLUSION: Targeted one-on-one education is a practical, effective, and safe method for reducing excessive broad-spectrum antibiotic use.

Aged↗
PubMedDate not supplied

A model for improving medication use in home health care patients.

OBJECTIVES: (1) To develop a model for the identification and resolution of problems associated with suboptimal medication use in elderly patients receiving home health care; (2) To select the most important identifiable problems and develop structured procedures for their resolution. DESIGN: Expert panel review, problem selection, and development of a problem resolution model and guidelines. SETTING: Home health care. PARTICIPANTS: A panel with expertise in home health nursing, pharmacy, clinical pharmacology, gerontology, pharmacoepidemiology, and health services research. INTERVENTIONS: A list of potential problems associated with the most frequently used classes of drugs was compiled for review by the panel. Problems that were controversial or that could not be identified in the home care setting were excluded. Panel members individually ranked the remainder. Detailed procedures for identification and resolution of the 15 top-ranking problems were developed. MAIN OUTCOME MEASURES: Not applicable. RESULTS: Potential medication problems were defined by both drug use and symptoms or clinical signs associated with specific adverse effects, to ensure that clinically relevant problems would be identified. The model developed for problem assessment and resolution was centered on the drug utilization review (DUR) coordinator and the attending home health nurse. Following guidelines developed by the panel, the DUR coordinator advises the home health nurse about identified problems and how to resolve them. One of these practitioners, usually the nurse, then contacts the attending physician to explain their concerns, offer potential solutions, and request instructions. CONCLUSION: A potentially useful model for the identification and resolution of medication problems in the home health care setting was developed. This model is currently being evaluated in a randomized controlled trial.

Aged↗
PubMedDate not supplied

Effect of hospitalwide change in clindamycin dosing schedule on clinical outcome.

We compared clinical outcomes of 65 hospitalized patients receiving clindamycin before and 59 after a sudden hospitalwide shift in dosing schedules for this drug from 600 mg every 6 hours to 600 mg every 8 hours. Outcomes studied included the efficacy of antibiotic treatment, length of febrile period, and frequency of adverse effects. We also compared and controlled for patient characteristics such as age, sex, presence of multiple diagnoses, length of therapy, and concurrent use of other antibiotics. There were no differences in measured clinical outcomes between the two groups. Treatment was successful in 87% of both groups. The average number of febrile days was 5.1 in the first group and 3.9 in the second (P less than .05). Patients on 6-hourly therapy experienced a 12% rate of antibiotic-related adverse effects vs. 5% for the 8-hourly group (P greater than .05). These data support the clinical rationale and safety of a hospitalwide reduction in the frequency of clindamycin dosing. In addition to considerable pharmacy and nursing time saved, this change also saved greater than $40,000 annually in antibiotic costs.

Bacterial Infections↗
PubMedDate not supplied

Information and education as determinants of antibiotic use: report of Task Force 5.

The "epidemiology of knowledge" underlying clinical decision making related to antibiotic therapy is one of the most important determinants of how such therapy is used, misused, or not used. A growing literature describes how prescribers and patients acquire the information that influences them in their utilization of these agents. The quality and content of this information ultimately determine whether a given microorganism will ever meet a particular drug. Most evidence indicates that there is considerable room for improvement in such decision making. Research data, including those from randomized controlled trials, have been used to compare the efficacy of several methods of improving the flow of information about proper antibiotic use. While traditional passive forms of education are not powerful means of changing prescribing behavior, innovative approaches, including person-to-person tutorials, can improve the quality of antibiotic prescribing. Benefit-cost analysis documents that these programs can save more than they cost. Additional research on these questions will be a powerful way of maximizing both effectiveness and efficiency in the treatment of infectious diseases.

Anti-Bacterial Agents↗