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  • 1
    Online Resource
    Online Resource
    Taking an Antibiotic Time-out: Utilization and Usability of a Self-Stewardship Time-out Program for Renewal of Vancomycin and Piperacillin-Tazobactam
    SAGE Publications ; 2015
    In:  Hospital Pharmacy Vol. 50, No. 11 ( 2015-12), p. 1011-1024
    Details
    In: Hospital Pharmacy, SAGE Publications, Vol. 50, No. 11 ( 2015-12), p. 1011-1024
    Abstract: Antibiotic time-outs can promote critical thinking and greater attention to reviewing indications for continuation. Objective We pilot tested an antibiotic time-out program at a tertiary care teaching hospital where vancomycin and piperacillin-tazobactam continuation past day 3 had previously required infectious diseases service approval. Methods The time-out program consisted of 3 components: (1) an electronic antimicrobial dashboard that aggregated infection-relevant clinical data; (2) a templated note in the electronic medical record that included a structured review of antibiotic indications and that provided automatic approval of continuation of therapy when indicated; and (3) an educational and social marketing campaign. Results In the first 6 months of program implementation, vancomycin was discontinued by day 5 in 93/145 (64%) courses where a time-out was performed on day 4 versus in 96/199 (48%) 1 year prior ( P = .04). Seven vancomycin continuations via template (5% of time-outs) were guideline-discordant by retrospective chart review versus none 1 year prior ( P = .002). Piperacillin-tazobactam was discontinued by day 5 in 70/105 (67%) courses versus 58/93 (62%) 1 year prior ( P = .55); 9 continuations (9% of time-outs) were guideline-discordant versus two 1 year prior ( P = .06). A usability survey completed by 32 physicians demonstrated modest satisfaction with the overall program, antimicrobial dashboard, and renewal templates. Conclusions By providing practitioners with clinical informatics support and guidance, the intervention increased provider confidence in making decisions to de-escalate antimicrobial therapy in ambiguous circumstances wherein they previously sought authorization for continuation from an antimicrobial steward.
    Type of Medium: Online Resource
    ISSN: 0018-5787 , 1945-1253
    URL: Article
    DOI: 10.1310/hpj5011-1011
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
    detail.hit.zdb_id: 2069227-4
    SSG: 15,3
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  • 2
    Online Resource
    Online Resource
    Antimicrobial Stewardship Programs: Comparison of a Program with Infectious Diseases Pharmacist Support to a Program with a Geographic Pharmacist Staffing Model
    SAGE Publications ; 2015
    In:  Hospital Pharmacy Vol. 50, No. 6 ( 2015-06), p. 477-483
    Details
    In: Hospital Pharmacy, SAGE Publications, Vol. 50, No. 6 ( 2015-06), p. 477-483
    Abstract: Stewardship of antimicrobial agents is an essential function of hospital pharmacies. The ideal pharmacist staffing model for antimicrobial stewardship programs is not known. Objective To inform staffing decisions for antimicrobial stewardship teams, we aimed to compare an antimicrobial stewardship program with a dedicated Infectious Diseases (ID) pharmacist (Dedicated ID Pharmacist Hospital) to a program relying on ward pharmacists for stewardship activities (Geographic Model Hospital). Methods We reviewed a randomly selected sample of 290 cases of inpatient parenteral antibiotic use. The electronic medical record was reviewed for compliance with indicators of appropriate antimicrobial stewardship. Results At the hospital staffed by a dedicated ID pharmacist, 96.8% of patients received initial antimicrobial therapy that adhered to local treatment guidelines compared to 87% of patients at the hospital that assigned antimicrobial stewardship duties to ward pharmacists ( P 〈 .002). Therapy was modified within 24 hours of availability of laboratory data in 86.7% of cases at the Dedicated ID Pharmacist Hospital versus 72.6% of cases at the Geographic Model Hospital ( P 〈 .03). When a patient's illness was determined not to be caused by a bacterial infection, antibiotics were discontinued in 78.0% of cases at the Dedicated ID Pharmacist Hospital and in 33.3% of cases at the Geographic Model Hospital ( P 〈 .0002). Conclusion An antimicrobial stewardship program with a dedicated ID pharmacist was associated with greater adherence to recommended antimicrobial therapy practices when compared to a stewardship program that relied on ward pharmacists.
    Type of Medium: Online Resource
    ISSN: 0018-5787 , 1945-1253
    URL: Article
    DOI: 10.1310/hpj5006-477
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
    detail.hit.zdb_id: 2069227-4
    SSG: 15,3
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    Online Resource
  • 3
    Online Resource
    Online Resource
    Effect of an education kiosk on patient knowledge about rapid HIV screening
    SAGE Publications ; 2010
    In:  Journal of Telemedicine and Telecare Vol. 16, No. 3 ( 2010-04), p. 158-161
    Details
    In: Journal of Telemedicine and Telecare, SAGE Publications, Vol. 16, No. 3 ( 2010-04), p. 158-161
    Abstract: Patient education is an important part of routine HIV screening. In a pilot study, we assessed the effect of a computer kiosk education module on patient knowledge about routine HIV screening. A systematic sample of walk-in clinic patients completed a questionnaire before and after using the education module. The primary outcome was a composite nine-point knowledge score. Secondary outcomes included willingness to undergo HIV screening and patient satisfaction. Of 185 patients who were eligible to participate, 100 completed the study. The median duration of kiosk interaction was 3.9 min. The median knowledge score increased from 7 to 8 ( P 〈 0.0001) after viewing the module. There was no significant change in the proportion of patients who were interested in HIV screening. The majority of patients expressed excellent (38%) or very good (39%) satisfaction with the kiosk module. The results suggest that a computer kiosk can deliver brief and targeted education to improve knowledge about HIV screening.
    Type of Medium: Online Resource
    ISSN: 1357-633X , 1758-1109
    URL: Article
    DOI: 10.1258/jtt.2009.090815
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2010
    detail.hit.zdb_id: 2007700-2
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  • 4
    Online Resource
    Online Resource
    Impact of a kiosk educational module on HIV screening rates and patient knowledge
    SAGE Publications ; 2011
    In:  Journal of Telemedicine and Telecare Vol. 17, No. 8 ( 2011-12), p. 446-450
    Details
    In: Journal of Telemedicine and Telecare, SAGE Publications, Vol. 17, No. 8 ( 2011-12), p. 446-450
    Abstract: We assessed the effect of a kiosk educational module on HIV screening rates and patient knowledge about HIV testing. The evaluation was performed in a walk-in clinic offering routine HIV screening. During alternating two-week periods, patients were referred either to view a kiosk-based, educational module prior to receiving usual care, or the kiosk module was turned off and no alterations to care processes were made. The primary outcome was HIV testing rate. The secondary outcome was knowledge about HIV rapid screening, as measured with a questionnaire. There were 71 patients in the kiosk periods and 79 patients in the usual-care periods. The overall HIV testing rate was 41%. The kiosk period was not associated with greater odds of HIV testing (OR 0.7; 95% CI: 0.4–1.4). In 44 patients who completed the knowledge survey, the kiosk group was strongly associated with increased knowledge (predicted increase in knowledge score: 1.3; 95% CI: 036–2.1). The brief kiosk educational module did not improve HIV screening rates, but it increased overall patient knowledge about HIV testing.
    Type of Medium: Online Resource
    ISSN: 1357-633X , 1758-1109
    URL: Article
    DOI: 10.1258/jtt.2011.110415
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2011
    detail.hit.zdb_id: 2007700-2
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  • 5
    Online Resource
    Online Resource
    Provider and Patient Correlates of Provider Decisions to Recommend HCV Treatment to HIV Co-Infected Patients
    SAGE Publications ; 2012
    In:  Journal of the International Association of Physicians in AIDS Care Vol. 11, No. 4 ( 2012-08), p. 245-251
    Details
    In: Journal of the International Association of Physicians in AIDS Care, SAGE Publications, Vol. 11, No. 4 ( 2012-08), p. 245-251
    Abstract: Despite low uptake of hepatitis C virus (HCV) treatment among HIV co-infected patients, few studies have examined the factors that contribute to provider decisions to recommend treatment. Surveys of 173 co-infected patients and their primary care providers, as well as patient chart data, were collected at 3 HIV clinics in Los Angeles; 73% of the patients had any history of being recommended HCV treatment. Multivariate predictors of being offered treatment included being Caucasian, greater HCV knowledge, receiving depression treatment if depressed, and one’s provider having a lower weekly patient load and more years working at the study site. These findings suggest that provider decisions to recommend HCV treatment are influenced by patient factors including race and psychosocial treatment readiness, as well as characteristics of their own practice and treatment philosophy. With changes to HCV treatment soon to emerge, further evaluation of factors influencing treatment decisions is needed to improve HCV treatment uptake.
    Type of Medium: Online Resource
    ISSN: 1545-1097
    URL: Article
    DOI: 10.1177/1545109712444163
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2012
    detail.hit.zdb_id: 2709037-1
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