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UBC Theses and Dissertations

Evaluating BC Provincial Academic Detailing Service’s intervention on antibiotic prescribing for suspected urinary tract infections in British Columbia’s nursing homes Sharma, Prateek


Background: From June 2016, an academic detailing (AD) intervention took place in 115 nursing homes (NHs) in British Columbia. Physicians, nurses, and NH staff received AD to reduce unnecessary antibiotic treatment. We hypothesized that local health areas (LHAs) with NHs visited by academic detailers experienced a decreasing trend in UTI-linked and overall antibiotic prescribing. Methods: We used population-based administrative datasets of services provided to NH residents from June 2015 till March 2017, aggregated by month for LHA intervention and control groups. Ecologic change in the UTI-linked and overall prescribing trend was evaluated with linear segmented regression. Sensitivity analysis to evaluate potential bias from linking antibiotic use to the occurrence of UTI-related diagnoses by fee-for-service provider’s billings was undertaken. Results: In the study period, there were 93,327 antibiotic prescriptions and 24,081 prescriptions linked to UTI diagnostic codes. For the UTI-linked analysis, the control’s antibiotic prescribing pre-intervention trend was a monthly decrease of -0.15 DDD/1,000 residents/day per month versus -0.09 after start of the intervention – a slope change of 0.06 (95% CI: -0.16 to 0.29) DDD/1,000 residents/day per month. The intervention group’s pre-intervention trend was almost identical to the controls’, a monthly decrease of -0.14 DDD/1,000 residents/day vs -0.27 after start of the intervention – a slope change of -0.13 (95% CI: -0.32 to -0.07) DDD/1,000 residents/day per month. The difference in slope changes was -0.19 (95% CI: -0.29 to 0.80) DDD/1,000 residents/day per month. The sensitivity analysis indicated that linkage bias was unlikely to bias the UTI-linked analysis’ trends. Conclusions: This ecologic study found that a population-level AD intervention was associated with decreases in UTI-linked prescribing trends but not overall prescribing trends.

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