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Improving antibiotic prescribing for community-acquired pneumonia in a provincial hospital in Northern Vietnam

OBJECTIVES: To test the effectiveness of a quality improvement programme to promote adherence to national quality standards (QS) for patients hospitalized with community-acquired pneumonia (CAP), exploring the factors that hindered improvements in clinical practice. METHODS: An improvement bundle al...

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Autores principales: Do, Nga T T, Li, Ryan, Dinh, Huong T T, Nguyen, Huong T L, Dao, Minh Q, Nghiem, Trang N M, Nadjm, Behzad, Luong, Khue N, Cao, Thai H, Le, Dung T K, Cluzeau, Francoise, Ngo, Chau Q, Chu, Hanh T, Vu, Dat Q, van Doorn, H Rogier, Roberts, C Michael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8127081/
https://www.ncbi.nlm.nih.gov/pubmed/34046595
http://dx.doi.org/10.1093/jacamr/dlab040
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author Do, Nga T T
Li, Ryan
Dinh, Huong T T
Nguyen, Huong T L
Dao, Minh Q
Nghiem, Trang N M
Nadjm, Behzad
Luong, Khue N
Cao, Thai H
Le, Dung T K
Cluzeau, Francoise
Ngo, Chau Q
Chu, Hanh T
Vu, Dat Q
van Doorn, H Rogier
Roberts, C Michael
author_facet Do, Nga T T
Li, Ryan
Dinh, Huong T T
Nguyen, Huong T L
Dao, Minh Q
Nghiem, Trang N M
Nadjm, Behzad
Luong, Khue N
Cao, Thai H
Le, Dung T K
Cluzeau, Francoise
Ngo, Chau Q
Chu, Hanh T
Vu, Dat Q
van Doorn, H Rogier
Roberts, C Michael
author_sort Do, Nga T T
collection PubMed
description OBJECTIVES: To test the effectiveness of a quality improvement programme to promote adherence to national quality standards (QS) for patients hospitalized with community-acquired pneumonia (CAP), exploring the factors that hindered improvements in clinical practice. METHODS: An improvement bundle aligned to the QS was deployed using plan-do-study-act methodology in a 600 bed hospital in northern Vietnam from July 2018 to April 2019. Proposed care improvements included CURB65 score guided hospitalization, timely diagnosis and inpatient antibiotic treatment review to limit the spectrum and duration of IV antibiotic use. Interviews with medical staff were conducted to better understand the barriers for QS implementation. RESULTS: The study found that improvements were made in CURB65 score documentation and radiology results available within 4 h (P < 0.05). There were no significant changes in the other elements of the QS studied. We documented institutional barriers relating to the health reimbursement mechanism and staff cultural barriers relating to acceptance and belief as significant impediments to implementation of the standards. CONCLUSIONS: Interventions led to some process changes, but these were not utilized by clinicians to improve patient management. Institutional and behavioural barriers documented may inhibit wider national uptake of the QS. National system changes with longer term support and investment to address local behavioural barriers are likely to be crucial for future improvements in the management of CAP, and potentially other hospitalized conditions, in Vietnam.
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spelling pubmed-81270812021-05-25 Improving antibiotic prescribing for community-acquired pneumonia in a provincial hospital in Northern Vietnam Do, Nga T T Li, Ryan Dinh, Huong T T Nguyen, Huong T L Dao, Minh Q Nghiem, Trang N M Nadjm, Behzad Luong, Khue N Cao, Thai H Le, Dung T K Cluzeau, Francoise Ngo, Chau Q Chu, Hanh T Vu, Dat Q van Doorn, H Rogier Roberts, C Michael JAC Antimicrob Resist Original Article OBJECTIVES: To test the effectiveness of a quality improvement programme to promote adherence to national quality standards (QS) for patients hospitalized with community-acquired pneumonia (CAP), exploring the factors that hindered improvements in clinical practice. METHODS: An improvement bundle aligned to the QS was deployed using plan-do-study-act methodology in a 600 bed hospital in northern Vietnam from July 2018 to April 2019. Proposed care improvements included CURB65 score guided hospitalization, timely diagnosis and inpatient antibiotic treatment review to limit the spectrum and duration of IV antibiotic use. Interviews with medical staff were conducted to better understand the barriers for QS implementation. RESULTS: The study found that improvements were made in CURB65 score documentation and radiology results available within 4 h (P < 0.05). There were no significant changes in the other elements of the QS studied. We documented institutional barriers relating to the health reimbursement mechanism and staff cultural barriers relating to acceptance and belief as significant impediments to implementation of the standards. CONCLUSIONS: Interventions led to some process changes, but these were not utilized by clinicians to improve patient management. Institutional and behavioural barriers documented may inhibit wider national uptake of the QS. National system changes with longer term support and investment to address local behavioural barriers are likely to be crucial for future improvements in the management of CAP, and potentially other hospitalized conditions, in Vietnam. Oxford University Press 2021-05-16 /pmc/articles/PMC8127081/ /pubmed/34046595 http://dx.doi.org/10.1093/jacamr/dlab040 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Do, Nga T T
Li, Ryan
Dinh, Huong T T
Nguyen, Huong T L
Dao, Minh Q
Nghiem, Trang N M
Nadjm, Behzad
Luong, Khue N
Cao, Thai H
Le, Dung T K
Cluzeau, Francoise
Ngo, Chau Q
Chu, Hanh T
Vu, Dat Q
van Doorn, H Rogier
Roberts, C Michael
Improving antibiotic prescribing for community-acquired pneumonia in a provincial hospital in Northern Vietnam
title Improving antibiotic prescribing for community-acquired pneumonia in a provincial hospital in Northern Vietnam
title_full Improving antibiotic prescribing for community-acquired pneumonia in a provincial hospital in Northern Vietnam
title_fullStr Improving antibiotic prescribing for community-acquired pneumonia in a provincial hospital in Northern Vietnam
title_full_unstemmed Improving antibiotic prescribing for community-acquired pneumonia in a provincial hospital in Northern Vietnam
title_short Improving antibiotic prescribing for community-acquired pneumonia in a provincial hospital in Northern Vietnam
title_sort improving antibiotic prescribing for community-acquired pneumonia in a provincial hospital in northern vietnam
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8127081/
https://www.ncbi.nlm.nih.gov/pubmed/34046595
http://dx.doi.org/10.1093/jacamr/dlab040
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