Adherence to Guidelines for Antibiotic Use in Respiratory Infections at Hospitals

NCT ID: NCT00129883

Last Updated: 2005-09-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

2000 participants

Study Classification

INTERVENTIONAL

Study Start Date

2002-09-30

Study Completion Date

2005-04-30

Brief Summary

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The purpose of this study is to test a strategy to improve the quality of antibiotic use in lower respiratory tract infections (LRTIs) at hospitals. Therefore, a multifaceted intervention strategy is compared to a control strategy and the effectiveness and feasibility of the intervention is assessed.

Detailed Description

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Improving processes of care in patients with hospital LRTI has been related to better patient outcome. Inappropriate use of antibiotics has contributed to the emergence and spread of drug-resistant micro organisms and increased treatment costs. International guidelines provide recommendations for the initial evaluation and management of LRTI, including advice on judicious antibiotic therapy. Nonetheless, studies have demonstrated a wide variability in adherence to these guidelines.

To implement key recommendations in clinical practice, various strategies have been used, with mixed results. Perhaps the most important aspect of choosing a potentially effective intervention is that the choice of intervention should be based upon assessment of potential barriers in the target group. Many intervention studies are flawed by failing to control for secular trends.

The investigators performed a cluster randomised controlled trial, to study the effect of a multifaceted intervention strategy on the quality of antibiotic use for LRTI. Their intervention was tailored to the areas most in need for improvement and took perceived barriers in the target group into consideration at the individual hospital level.

Conditions

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Pneumonia Chronic Bronchitis COPD

Keywords

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quality of care antibiotic use intervention lower respiratory tract infections Community acquired Pneumonia Acute Exacerbation of Chronic Bronchitis or COPD

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

ECT

Blinding Strategy

NONE

Interventions

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Professional education

Intervention Type BEHAVIORAL

Implementation of a Critical Care Pathway

Intervention Type BEHAVIORAL

Professional audit and feedback

Intervention Type BEHAVIORAL

Process analysis and redesign

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Patients admitted to a respiratory care or internal medicine ward with community-acquired pneumonia or acute exacerbation of chronic bronchitis or chronic obstructive pulmonary disease (COPD)

Exclusion Criteria

* Recent (\< 30 days) admission for LRTI
* Patients with underlying immunodeficiency (HIV infection, neutropenia, treatment with immunomodulating drugs, active hematological malignancies, anatomical or functional asplenia and hypogammaglobulinemia)
* Patients already on treatment with antibiotics for another culture proven infection at the time of admission
* Patients from nursing homes
* Patients who had been transferred to another hospital or ICU and patients who had died within 24 hours of admission
* Patients with very poor prognosis (life expectancy \< 2 weeks on admission).
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Radboud University Medical Center

OTHER

Sponsor Role lead

Principal Investigators

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Marlies E Hulscher, MSc, PhD

Role: PRINCIPAL_INVESTIGATOR

Centre for Quality of Care Research, Radboud University Nijmegen Medical Centre

Richard P Grol, MSc, PhD

Role: STUDY_DIRECTOR

Centre for Quality of Care Research, Radboud University Nijmegen Medical Centre

Jos WM van der Meer, MD, PhD

Role: STUDY_DIRECTOR

Department of General Internal Medicine, Radboud University Nijmegen Medical Centre

Locations

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Gelre Ziekenhuizen

Apeldoorn, , Netherlands

Site Status

Deventer Ziekenhuis

Deventer, , Netherlands

Site Status

Ziekenhuis Gelderse Vallei

Ede, , Netherlands

Site Status

Bernhoven Ziekenhuis

Oss, , Netherlands

Site Status

Bernhoven Ziekenhuis

Veghel, , Netherlands

Site Status

Maxima Medisch Centrum

Veldhoven, , Netherlands

Site Status

Vie Curi Medisch Centrum

Venlo, , Netherlands

Site Status

Countries

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Netherlands

Related Links

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http://www.wokresearch.nl

website of Centre for Quality of Care Research, department of the Radboud University Nijmegen Medical Centre, where this study was carried out

Other Identifiers

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ZonMw grant no. 2300.0024

Identifier Type: -

Identifier Source: secondary_id

AGAR-2001-1

Identifier Type: -

Identifier Source: org_study_id