Life In The Slower Lane

Here is the standardised PICO analysis for the uploaded article:

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Full Title

Can a multifaceted educational intervention targeting both nurses and physicians change the prescribing of antibiotics to nursing home residents? A cluster randomized controlled trial

Authors: Eva Pettersson, Åsa Vernby, Sigvard Mölstad, Cecilia Stålsby Lundborg

Journal: Journal of Antimicrobial Chemotherapy, 2011; 66(11): 2659–2666

DOI: 10.1093/jac/dkr312

Type of Study

Cluster Randomised Controlled Trial (quantitative)

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PICO Summary

Population (P)

• Residents of 58 Swedish nursing homes (final analysis: 46 homes, 2,511 residents)
• Mean age: ~84 years
• Setting: Long-term care/nursing homes with shared dining and staffing
• Inclusion: Stable staffing, general elderly care
• Exclusion: Specialised nursing homes (e.g. oncology wards)

Intervention (I)

• A multifaceted educational intervention targeting both nurses and physicians
  • Included:
    • Two 1.5-hour educational sessions
    • Feedback on prescribing
    • Local guidelines for antibiotic use
    • Hygiene leaflets
    • Written summaries
    • Facilitators (physician, pharmacist, hygiene nurse)

Comparison (C)

• Control group: Received no intervention during study period
• Some exposure crossover occurred (two control homes attended education sessions uninvited)
• Comparison is between intervention vs. control group (usual care without educational support)

Outcomes (O)

Primary Outcome:

• Change in proportion of quinolones prescribed for lower UTI in women

Secondary Outcomes:

• Person-centred: Not directly addressed
• Process outcomes:
  • Proportion of infections treated with antibiotics
  • Proportion of cases managed by physicians with “wait and see”
  • Proportion of nitrofurantoin use for lower UTI in women
  • Number of UTIs per resident
• Health system outcomes:
  • Admission to hospital (used as a safety signal)

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Findings Summary

• The primary outcome (reduction in quinolone use) improved in both groups but not significantly more in the intervention group
• The intervention group showed a significant reduction in overall antibiotic prescribing and a significant increase in “wait and see” approaches
• No increase in hospital admissions observed in either group

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