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Sukhjinder Sidhu Sean Gorman Richard Slavik Nicole Bruchet Sarah Murray Tasha Ramsey

Assessment of the Effect of Behavioral Change Strategies on K nowledge T ranslation and P harmacist I nterventions for A ntimicrobial S tewardship: PIAS-KT Study. Sukhjinder Sidhu Sean Gorman Richard Slavik Nicole Bruchet Sarah Murray Tasha Ramsey. Background.

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Sukhjinder Sidhu Sean Gorman Richard Slavik Nicole Bruchet Sarah Murray Tasha Ramsey

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  1. Assessment of the Effect of Behavioral Change Strategies on Knowledge Translation and Pharmacist Interventions for Antimicrobial Stewardship: PIAS-KT Study Sukhjinder Sidhu Sean Gorman Richard Slavik Nicole Bruchet Sarah Murray Tasha Ramsey

  2. Background • Pharmacist’s prevent, identify and resolve drug therapy problems (DTPs) • Priority disease states are prevalent diseases which account for a large proportion of health care utilization and costs • ED visits, hospitalizations, prolonged length of stay • RCTs have shown that pharmacists resolving priority disease state DTPs can improve quality of drug therapy and decrease health care utilization and costs

  3. Background • Continuous professional development allows pharmacists to optimize care for patients with priority disease states • Eight 4-week disease state education modules (DSEMs) were implemented at IH in 2009 • At the end of each DSEM, lists of key pharmacist interventions (DSEM KPI) or evidence-based interventions proven to reduce mortality, morbidity, health utilization were developed to guide interventions

  4. Background • DSEMs improved the knowledge, skills, abilities, competence and confidence of pharmacists • AIMS study showed that after providing DSEMs there was a statistically significant increase in the process of care outcomes (DSEM DTPs and DSEM KPIs), but opportunity for improvement still exists

  5. Rationale • Knowledge translation (KT) is defined as a dynamic and iterative process that includes the synthesis, dissemination, exchange of ethically sound application of knowledge to improve health, provide more effective health services and products, and strengthen the health care system

  6. Rationale • Professional behavioral change strategies shown to improve professional practice and health outcomes include: • Audit and feedback; local opinion leaders; educational meetings; educational outreach/academic detailing; printed education material; and reminders • Proof of concept: • DSEM-KT study showed that multifaceted behavioral change strategies significantly improved the KT for heart failure therapeutics and modified behavior of IH clinical pharmacists (DSEM DTP and DSEM KPI)

  7. Rationale • There is increasing concern for antibiotic resistance as infections caused by multi-drug resistant bacteria are associated with higher mortality and prolonged hospital stay • Accreditation Canada states “organizations have a program for antimicrobial stewardship to optimize antimicrobial use to aid in ensuring the safe use of high-risk medications”

  8. Rationale • Goals of antimicrobial stewardship are to ensure effective treatment of patients with infection and to minimize collateral damage from antimicrobial use • Currently at IH the following antimicrobial stewardship interventions are in place: • Formulary restrictions; therapeutic substitutions; automatic stop dates; and selective reporting of antimicrobial susceptibilities

  9. Rationale • Majority of evidence has shown impact of restrictive interventions on antimicrobial prescribing appropriateness, but little evidence exists on benefits of persuasive interventions • No studies have evaluated the impact of all 6 behavioral change interventions, which are persuasive, on patient outcomes, microbial outcomes, or prescribing appropriateness outcomes

  10. Purpose • To evaluate the impact of the provision of multifaceted professional behavioral change strategies on resolution of DSEM DTPs and DSEM KPIs for disease X pts by IH pharmacists

  11. Significance • If multifaceted professional behavioral change strategies increase knowledge translation and improve process of care outcomes for disease X, this will directly improve antimicrobial prescribing appropriateness for disease X • Improved antimicrobial prescribing is an acceptable surrogate for patient-important and health-system important outcomes

  12. Methods Design • Prospective quasi-experimental, one group, pre/post study to evaluate the impact of a bundle of proven professional behavioral change strategies on process of care measures Setting • Tertiary (KGH, RIH); regional (PRH, VJH, EKH, KBH); community (SOH, SLH, KLH, OMH, CMH) pharmacy departments (July 1/13 to June 30/14)

  13. Methods Inclusion Criteria • PRE intervention quiz (Jan 6 to Jan 19/14), a multifaceted professional behavioral change intervention (Jan 20 to Feb 28/14), and a POST intervention quiz (Mar 3 to Mar 16/14) will be administered to all IH clinical pharmacists and residents • Quiz results and DTP data during the PRE intervention phase (July 1 to Dec 31/13) and the POST intervention phase (Jan 1 to June 30/14)

  14. Methods Intervention • Bundle of multifaceted proven professional behavioral change strategies improve KT for disease X KPIs will be administered • Audit and feedback on DSEM DTPs and DSEM KPIs • Local opinion leader support formalized at each site • Educational intervention via Web-X • Educational outreach visits or via Web-X • Printed education materials on DSEM KPI content • Multimodal reminders

  15. Methods Primary Outcome • Change in proportion of disease X DTP/DSEM DTPs from the PRE to the POST intervention phase Secondary Outcomes • Change in proportion of disease X KPI/DSEM KPI from the PRE to the POST intervention phase • Change in pharmacists’ quiz scores on disease X KPI therapeutics from the PRE to the POST intervention phase • To compare the change in the prevalence of DSEM DTPs being resolved by IH pharmacists

  16. Methods Intervention PRE phase POST phase Knowledge Knowledge Behavior Behavior Behavioral Change Strategies DTP/DSEM DTP KPI/DSEM KPI DTP/DSEM DTP KPI/DSEM KPI Quiz Quiz 1. Audit & Feedback 2. Local opinion leaders 3. Educational meetings 4. Educational outreach 5. Printed education materials 6. Reminders

  17. Methods Statistical Analysis Based on a 6-month disease X DTP count of n=936, study will be powered to detect a 15% relative risk increase (RRI) and 2.5% absolute risk increase (ARI) in the primary outcome for a 6-month PRE and POST sample period using an α ≤ 0.05, and power=0.8 Primary outcome will be analyzed with a test of proportions with two-tailed p-value adjusted to p≤0.05 Mean (SD) differences in pharmacist quiz scores will be compared with the paired Student’s t- test

  18. Limitations • Implementation of antimicrobial stewardship during study • Selection bias • Intervention bias • Measurement bias

  19. Questions

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