Improving antibiotic utilization among hospitalists: a pilot academic detailing project with a public health approach

Abstract

Background: Inappropriate use of antibiotics is a major clinical problem and public health concern. We developed and implemented a pilot hospitalist-delivered academic detailing intervention to improve the patterns of antibiotic prescribing for inpatients.

Objective: To improve antibiotic prescribing patterns on the hospitalist service of an academic medical center.

Design, setting, and participants: Hospitalist practitioners were recruited to participate in this pre- and postintervention pilot study at Johns Hopkins Bayview Medical Center (JHBMC). Public health principles for creating a conceptual framework based on behavioral change theory were used in developing the intervention.

Methods: Antibiotic prescribing patterns of 17 hospitalist practitioners were retrospectively reviewed. Antimicrobial prescriptions were classified as appropriate, effective but inappropriate, or inappropriate. A profile was assembled for each hospitalist, and an academic detailing intervention session was arranged. The session reviewed inappropriate prescribing practices as well as current practice guidelines. After the detailing meeting, the prescribing patterns of the hospitalists were followed prospectively.

Main outcome measures: The main outcome measures were the proportions of antibiotics prescribed inappropriately before the intervention, during the detailing period, and after the intervention.

Results: Seventeen hospitalist practitioners who participated in the study. A total of 247 prescriptions were reviewed in the preintervention and 129 prescriptions in the postintervention period. Prior to academic detailing, 43% (95% CI 37%-49%) of the prescriptions were appropriate and 57% (95% CI 51%-63%) were inappropriate. After the intervention, 74% (95% CI 65%-81%) of the prescriptions were appropriate and 26% (95% CI 19%-35%) were inappropriate; P < .0001.

Conclusions: A carefully planned and methodically executed intervention can result in behavior change, even among busy hospitalists. The academic detailing intervention, which included a practice-based learning component, improved antibiotic prescribing practices of hospitalists at JHBMC.