Assessing the efficacy of pharmacist-engaged interventions in influencing antibiotic prescribing behavior among general practitioners: meta-analysis
Abstract
Background: A meta-analysis study was undertaken to examine antibiotic resistance, specifically by assessing the effectiveness of pharmacist interventions in influencing the rate of antibiotic prescriptions compared to their impact on adherence to antibiotic prescribing guidelines.
Objective: Evaluating the effectiveness of pharmacist interventions in influencing the rate of antibiotic prescriptions, in contrast to their impact on adherence to antibiotic prescribing guidelines.
Method: A comprehensive literature review up to the year 2016 was conducted, examining a total of 215 relevant studies. Among these, 15 specific studies were chosen for inclusion, encompassing a population of 298,339 individuals who initially demonstrated antibiotic resistance. Within this group, 134,004 individuals were exposed to interventions involving pharmacist participation, while 164,335 served as controls. The calculation of odds ratios (OR) and 95% confidence intervals (CIs) was employed to assess antibiotic resistance in pharmacists involved in antibiotic prescribing rates as compared to those involved in antibiotic prescribing adherence rates. This analysis utilized dichotomous approaches and employed both fixed and random models.
Result: When pharmacists participated in interventions targeting antibiotic prescribing rates, a considerable reduction in antibiotic resistance was observed (Odds Ratio, 0.86; 95% Confidence Interval, 0.78-0.95, p<0.00001). However, these findings exhibited a significant degree of heterogeneity (I2 = 90%). Conversely, in interventions focusing on improving antibiotic prescribing adherence rates involving pharmacists, a substantial increase in antibiotic resistance was noted (Odds Ratio, 1.96; 95% Confidence Interval, 1.56-2.45, p<0.00001), with similarly high heterogeneity in the results (I2 = 91%). These outcomes were specifically evident in individuals grappling with antibiotic resistance issues.
Conclusion: Pharmacist-led interventions targeting antibiotic prescribing rates led to a noteworthy decrease in antibiotic resistance compared to scenarios without pharmacist involvement in such interventions. Nonetheless, it is crucial to approach the interpretation of these results with caution, given the limited sample size in certain studies incorporated into the meta-analysis.
Share and Cite
Article Metrics
References
- Davies, J. and Davies, D., Origins and Evolution of Antibiotic Resistance. Microbiology and Molecular Biology Reviews, 2010. 74(3): p. 417-433.
- Frieri, M., Kumar, K., and Boutin, A., Antibiotic resistance. Journal of Infection and Public Health, 2017. 10(4): p. 369-378.
- Khan, H., Malik, A., Gaur, P.K., et al., Antibiotic resistance: a universal issue of concern. Journal of Pharmacy Practice and Community Medicine, 2022. 8(1).
- Garau, J. and Bassetti, M., Role of pharmacists in antimicrobial stewardship programmes. International journal of clinical pharmacy, 2018. 40(5): p. 948-952.
- Buckel, W.R., Veillette, J.J., Vento, T.J., et al., Antimicrobial stewardship in community hospitals. Medical Clinics, 2018. 102(5): p. 913-928.
- Cresswell, K., Hinder, S., Sheikh, A., et al., ePrescribing-based antimicrobial stewardship practices in an English National Health Service Hospital: qualitative interview study among medical prescribers and pharmacists. JMIR formative research, 2023. 7(1): p. e37863.
- Klepser, M.E., Adams, A.J., and Klepser, D.G., Antimicrobial stewardship in outpatient settings: leveraging innovative physician-pharmacist collaborations to reduce antibiotic resistance. Health security, 2015. 13(3): p. 166-173.
- Rabbani, S.A., Sridhar, S.B., Safdar, M., et al., Assessment of prescribing practices and factors related to antibiotic prescribing in community pharmacies. Medicina, 2023. 59(5): p. 843.
- Piraux, A., Hammoud, R., Riou, J., et al., Assessment of the Compliance of Cystitis Management According to French Recommendations through the Analysis of Prescriptions Collected in Community Pharmacies. Antibiotics, 2022. 11(7): p. 976.
- Aminov, R.I., A brief history of the antibiotic era: lessons learned and challenges for the future. Frontiers in microbiology, 2010. 1: p. 134.
- Aslam, B., Wang, W., Arshad, M.I., et al., Antibiotic resistance: a rundown of a global crisis. Infection and drug resistance, 2018: p. 1645-1658.
- Kokane, J.V. and Avhad, P.S., Role of pharmacist in health care system. J Community Health Manag, 2016. 3(1): p. 37-40.
- Mansour, O. and Al-Kayali, R., Community pharmacistsꞌ role in controlling bacterial antibiotic resistance in Aleppo, Syria. Iranian journal of pharmaceutical research: IJPR, 2017. 16(4): p. 1612.
- Hernandez, A.V., Marti, K.M., and Roman, Y.M., Meta-analysis. Chest, 2020. 158(1): p. S97-S102.
- Macaskill, P., Takwoingi, Y., Deeks, J.J., et al., Understanding meta‐analysis. Cochrane handbook for systematic reviews of diagnostic test accuracy, 2023: p. 203-247.
- Liberati, A., Altman, D.G., Tetzlaff, J., et al., The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. Bmj, 2009. 339.
- Lee, S.W. and Koo, M.J., PRISMA 2020 statement and guidelines for systematic review and meta-analysis articles, and their underlying mathematics: Life Cycle Committee Recommendations. Life Cycle, 2022. 2.
- Sheikhbahaei, S., Trahan, T.J., Xiao, J., et al., FDG-PET/CT and MRI for evaluation of pathologic response to neoadjuvant chemotherapy in patients with breast cancer: a meta-analysis of diagnostic accuracy studies. The oncologist, 2016. 21(8): p. 931-939.
- Coenen, S., Van Royen, P., Michiels, B., et al., Optimizing antibiotic prescribing for acute cough in general practice: a cluster-randomized controlled trial. Journal of Antimicrobial Chemotherapy, 2004. 54(3): p. 661-672.
- Esmaily, H.M., Silver, I., Shiva, S., et al., Can rational prescribing be improved by an outcome-based educational approach? A randomized trial completed in Iran. Journal of Continuing Education in the Health Professions, 2010. 30(1): p. 11-18.
- Ilett, K.F., Johnson, S., Greenhill, G., et al., Modification of general practitioner prescribing of antibiotics by use of a therapeutics adviser (academic detailer). British journal of clinical pharmacology, 2000. 49(2): p. 168-173.
- Martens, J.D., Winkens, R.A., van der Weijden, T., et al., Does a joint development and dissemination of multidisciplinary guidelines improve prescribing behaviour: a pre/post study with concurrent control group and a randomised trial. BMC health services research, 2006. 6: p. 1-8.
- Saint, S., Scholes, D., Fihn, S.D., et al., The effectiveness of a clinical practice guideline for the management of presumed uncomplicated urinary tract infection in women∗. The American journal of medicine, 1999. 106(6): p. 636-641.
- De Santis, G., Harvey, K., Howard, D., et al., Improving the quality of antibiotic prescription patterns in general practice. The role of educational intervention. The Medical Journal of Australia, 1994. 160(8): p. 502-505.
- Smeets, H., Kuyvenhoven, M., Akkerman, A., et al., Intervention with educational outreach at large scale to reduce antibiotics for respiratory tract infections: a controlled before and after study. Family practice, 2009. 26(3): p. 183-187.
- Lundborg, C.S., Wahlström, R., Oke, T., et al., Influencing prescribing for urinary tract infection and asthma in primary care in Sweden: a randomized controlled trial of an interactive educational intervention. Journal of clinical epidemiology, 1999. 52(8): p. 801-812.
- Van Driel, M., Coenen, S., Dirven, K., et al., What is the role of quality circles in strategies to optimise antibiotic prescribing? A pragmatic cluster-randomised controlled trial in primary care. BMJ Quality & Safety, 2007. 16(3): p. 197-202.
- Vellinga, A., Galvin, S., Duane, S., et al., Intervention to improve the quality of antimicrobial prescribing for urinary tract infection: a cluster randomized trial. Cmaj, 2016. 188(2): p. 108-115.
- Veninga, C., Denig, P., Zwaagstra, R., et al., Improving drug treatment in general practice. Journal of clinical epidemiology, 2000. 53(7): p. 762-772.
- Vervloet, M., Meulepas, M.A., Cals, J.W., et al., Reducing antibiotic prescriptions for respiratory tract infections in family practice: results of a cluster randomized controlled trial evaluating a multifaceted peer-group-based intervention. NPJ primary care respiratory medicine, 2016. 26(1): p. 1-6.
- Weiss, K., Blais, R., Fortin, A., et al., Impact of a multipronged education strategy on antibiotic prescribing in Quebec, Canada. Clinical infectious diseases, 2011. 53(5): p. 433-439.
- Welschen, I., Kuyvenhoven, M.M., Hoes, A.W., et al., Effectiveness of a multiple intervention to reduce antibiotic prescribing for respiratory tract symptoms in primary care: randomised controlled trial. Bmj, 2004. 329(7463): p. 431.
- Wilf-Miron, R., Ron, N., Ishai, S., et al., Reducing the volume of antibiotic prescriptions: a peer group intervention among physicians serving a community with special ethnic characteristics. Journal of Managed Care Pharmacy, 2012. 18(4): p. 324-328.
- Qin, Y., Han, H., Xue, Y., et al., Comparison and trend of perioperative outcomes between robot-assisted radical prostatectomy and open radical prostatectomy: nationwide inpatient sample 2009-2014. International braz j urol, 2020. 46(5): p. 754-771.
- Ryu, J., Kwon, T., Kyung, Y.S., et al., Retropubic versus robot-assisted laparoscopic prostatectomy for prostate cancer: a comparative study of postoperative complications. Korean Journal of Urology, 2013. 54(11): p. 756-761.
- Sugihara, T., Yasunaga, H., Horiguchi, H., et al., Robot‐assisted versus other types of radical prostatectomy: Population‐based safety and cost comparison in Japan, 2012–2013. Cancer Science, 2014. 105(11): p. 1421-1426.
- Tafuri, A., Sebben, M., Pirozzi, M., et al., Predictive factors of the risk of long-term hospital readmission after primary prostate surgery at a single tertiary referral center: preliminary report. Urologia Internationalis, 2020. 104(5-6): p. 465-475.
- Tewari, A., Srivasatava, A., Menon, M., et al., A prospective comparison of radical retropubic and robot‐assisted prostatectomy: experience in one institution. BJU international, 2003. 92(3): p. 205-210.
- Wallerstedt, A., Tyritzis, S.I., Thorsteinsdottir, T., et al., Short-term results after robot-assisted laparoscopic radical prostatectomy compared to open radical prostatectomy. European urology, 2015. 67(4): p. 660-670.
- Wallerstedt Lantz, A., Stranne, J., Tyritzis, S.I., et al., 90-Day readmission after radical prostatectomy—a prospective comparison between robot-assisted and open surgery. Scandinavian Journal of Urology, 2019. 53(1): p. 26-33.
- Pilecki, M.A., McGuire, B.B., Jain, U., et al., National multi-institutional comparison of 30-day postoperative complication and readmission rates between open retropubic radical prostatectomy and robot-assisted laparoscopic prostatectomy using NSQIP. Journal of Endourology, 2014. 28(4): p. 430-436.
- Osmonov, D.K., Faddan, A.A., Aksenov, A.V., et al., Surgical site infections after radical prostatectomy: a comparative study between robot-assisted laparoscopic radical prostatectomy and retropubic radical prostatectomy. Turkish journal of urology, 2018. 44(4): p. 303.
- Nelson, B., Kaufman, M., Broughton, G., et al., Comparison of length of hospital stay between radical retropubic prostatectomy and robotic assisted laparoscopic prostatectomy. The Journal of urology, 2007. 177(3): p. 929-931.
- Menon, M., Tewari, A., Baize, B., et al., Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology, 2002. 60(5): p. 864-868.
- Lenfant, L., Sawczyn, G., Aminsharifi, A., et al., Pure single-site robot-assisted radical prostatectomy using single-port versus multiport robotic radical prostatectomy: a single-institution comparative study. European urology focus, 2021. 7(5): p. 964-972.
- Johnson, I., Ottosson, F., Diep, L.M., et al., Switching from laparoscopic radical prostatectomy to robot assisted laparoscopic prostatectomy: comparing oncological outcomes and complications. Scandinavian journal of urology, 2018. 52(2): p. 116-121.
- Ficarra, V., Novara, G., Artibani, W., et al., Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. European urology, 2009. 55(5): p. 1037-1063.
- Di Pierro, G.B., Baumeister, P., Stucki, P., et al., A prospective trial comparing consecutive series of open retropubic and robot-assisted laparoscopic radical prostatectomy in a centre with a limited caseload. European urology, 2011. 59(1): p. 1-6.
- Carlsson, S., Nilsson, A.E., Schumacher, M.C., et al., Surgery-related complications in 1253 robot-assisted and 485 open retropubic radical prostatectomies at the Karolinska University Hospital, Sweden. Urology, 2010. 75(5): p. 1092-1097.
- Brooks, N.A., Boland, R.S., Strigenz, M.E., et al. Nongenitourinary complications associated with robot-assisted laparoscopic and radical retropubic prostatectomy: a single institution assessment of 1,100 patients over 11 years. in Urologic Oncology: Seminars and Original Investigations. 2018. Elsevier.
- Hagras, A., Ghaith, A., Alenzi, M., et al., Retzius-sparing robot-assisted radical prostatectomy versus open retropubic radical prostatectomy: a prospective comparative study with 19-month follow-up. Minerva Urologica e Nefrologica= The Italian Journal of Urology and Nephrology, 2020. 72(5): p. 586-594.