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Do Case Vignettes Accurately Reflect Antibiotic Prescription?

Published online by Cambridge University Press:  02 January 2015

Jean-Christophe Lucet ,
Marie-Hélène Nicolas-Chanoine ,
Agnes Lefort ,
Carine Roy ,
Sylvain Diamantis ,
Emmanuelle Papy ,
Oscar Riveros-Palacios ,
Jennifer Le Grand ,
Christophe Rioux  and
Bruno Fantin
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Jean-Christophe Lucet*
Affiliation:
Infection Control Unit, Bichat-Claude Bernard Hospital, Assistance Publique–Hôpitaux de Paris, Paris and Université Paris Diderot, Sorbonne Paris Cité, France
Marie-Hélène Nicolas-Chanoine
Affiliation:
Bacteriology Unit, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, and Université Paris Diderot, Sorbonne Paris Cité, France
Agnes Lefort
Affiliation:
Internal Medicine Unit, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy and Université Paris Diderot, Sorbonne Paris Cité, France
Carine Roy
Affiliation:
Département d'Epidémiologie, Biostatistique et Recherche Clinique, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris and Université Paris Diderot, Sorbonne Paris Cité, France
Sylvain Diamantis
Affiliation:
Infection Control Unit, Bichat-Claude Bernard Hospital, Assistance Publique–Hôpitaux de Paris, Paris and Université Paris Diderot, Sorbonne Paris Cité, France
Emmanuelle Papy
Affiliation:
Pharmacy Unit, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
Oscar Riveros-Palacios
Affiliation:
Infection Control Unit, Bichat-Claude Bernard Hospital, Assistance Publique–Hôpitaux de Paris, Paris and Université Paris Diderot, Sorbonne Paris Cité, France
Jennifer Le Grand
Affiliation:
Pharmacy Unit, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
Christophe Rioux
Affiliation:
Infectious Diseases Department, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
Bruno Fantin
Affiliation:
Internal Medicine Unit, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy and Université Paris Diderot, Sorbonne Paris Cité, France
Philippe Ravaud
Affiliation:
Département d'Epidémiologie, Biostatistique et Recherche Clinique, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris and Université Paris Diderot, Sorbonne Paris Cité, France
*
Unité d'Hygiène et de Lutte contre l'lnfection Nosocomiale, GH Bichat-Claude Bernard, 75877 Paris Cedex 18, France (jean-christophe.lucet@bch.aphp.fr)
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Abstract

Background.

Antibiotic prescription is frequently inappropriate in hospitals. Our objective was to evaluate whether the quality of antibiotic prescription could be measured using case vignettes to assess physicians' knowledge.

Methods.

The study was conducted in 2 public teaching hospitals, where 33/41 units and 206/412 physicians regularly prescribing antibiotics to inpatients agreed to participate. A cross-sectional survey of knowledge was performed using 4 randomly assigned case vignette sets. Curative antibiotic prescriptions were then evaluated using standard criteria for appropriateness at initiation (day 0), after 2–3 days of treatment (days 2–3), and at treatment completion. We compared knowledge of the physicians with their observed prescriptions in the subset of 106 physicians who completed the case vignettes and prescribed antibiotics at least once.

Results.

The median global case vignette score was 11.4/20 (interquartile range, 8.92-314.3). Of the 483 antibiotic prescriptions, 314 (65%) were deemed appropriate at day 0, 324 (72%) on days 2–3, and 227 (69%) at treatment completion. Prescriptions were appropriate at all 3 time points in only 43% of patients. Appropriate prescription was positively and independently associated with emergency prescription on day 0, documented infection on days 2–3, and 1 of the 2 hospitals at treatment completion. In addition, appropriateness at the 3 evaluation times was positively associated with prescription in anesthesiology or the intensive care unit. Case vignette scores above the median were significantly and independently associated with appropriate antibiotic prescription on days 2–3 and at treatment completion.

Conclusions.

Case vignettes are effective for identifying physicians or hospitals whose knowledge and practice regarding antibiotic prescription require improvement.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 10 , October 2011 , pp. 1003 - 1009
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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