Thursday, December 12, 2019
Intervention of Non-Communicable Disease for Peer Comparisons
Question: Discuss about theIntervention of Non-Communicable Disease for Peer Comparisons. Answer: The article by Meeker et al. (2016) reviews the use of a behavioral intervention to prevent acute respiratory tract infection which is a non-communicable infection, to reducing antibiotic use that causes serious effects. The behavioral interventions can be implemented together or in isolation. They include suggested alternatives, accountable justification, and peer comparisons. Suggested options present electronic order sets that suggested nonantibiotic treatment. Responsible justifications involved clinicians in using patients file to prescribe antibiotics into the health records of the patient without seeing the patient. Peer comparison involved comparing the performance of top performance with their lower prescribed antibiotics rate. The behavioral intervention was going to be measured by the standards at which patient pick antibiotic drugs from the clinic. It was realized that during the baseline period when the intervention had not been done the rates were recorded very high at 24%. The rates after the three intervention had dropped to 11%. The use of the three interventions had led to the drop of inappropriate antibiotic prescribing for acute respiratory infections. Despite free publications of how overuse of antibiotics exposes patients to the unnecessary risk of prevalence of bacteria. Most clinicians persist in giving out this drugs for the respiratory tract infection as is in the clinical guidelines. This leads to the rise of the need to find a behavioral solution. Researchers are also exploiting psychological issues as a way of remedying the stalemate. They focus on cognitive and psychological measures, like the ones used in this case. The research used being cognitive modeled adheres to the psychological demands. Several studies have shown that antibiotics are wrongly prescribed to patients instead of using alternatives method such as the ones used above. The intervention effect that was observed represent deductions inappropriate prescribing of drugs. The Hawthorne effect was the one applied to the control condition, this involved. The alteration of individual behavior for the impact and fear of being observed. As the patients were sure they were being seen as the disease, they changed their behavior to ones that suit them. The change of conduct led to low antibiotic rate, therefore, proving the intervention worked. Hawthorne theory was therefore relevant to the intervention. Previous studies on antibiotic justification notes have shown that when this method is used without public accountability to the patient, a negative result will be realized. With the target being peers intervention method prove the best in comparison with adult feedback. The findings across the two studies are consistent and consistent. Comparing to the model of Gerber et al. where the model trajectories are used (Meeker et al., 2016). The control taken early is inconsistent with the 24% recorded by the same that uses the same time of intervention, 18 months. This model measures the effect of each intervention on all the practices that did not receive the intervention (Kotwani, Joshi, Jhamb Holloway, 2017). The design also is in line with the approach of the primary model used when testing the diagnosis shift. The potential antibiotic, appropriate for infection diagnosed increased with the increase of the respiratory tract infection. Elements of analytic approach were also in line with the one used. Hierarchical modeling that involves performing the interaction based analysis. The original investigation used during the feedback produced the same result (Dekker et al., 2018). The result is plausible based on the following reasons; There isnt any potential harm .the three intervention as recorded within the 18 months of intervention did not cause any documented injuries to anyone. The damage that was feared for the group that was using all the three methods could deteriorate fast did not happen (Harris, Hicks Qaseem, 2016). This, therefore, proves that the technique was clinical and can be implemented without harm. None of the intervention required severe changes to the environment. The peer comparison was expected to change the primary care practices of some patients, but it did not. It turned to be most pragmatic and the simplest to perform. The intervention, therefore, is plausible as minimal changes are done to the environment (Hovi, Ollgren Savolainen-Kopra, 2017). There is a temporal relationship between the three interventions to the outcome; It is very likely that after the intervention. The rates might go up again especially for the group that used peer comparison as a way of intervention; this is because it did not involve a lot of changes, making it easier to slide back to the use of antibiotics. The healthy relationship between the methods and the outcome is present. The intervention methods accountable justification as the behavioral intervention cause a significant change in the environmental health of the individual. Therefore it is behavioral that the individual will adapt leading to a somewhat permanent outcome. The somewhat stable outcome shows, there is a healthy relationship between the result and the intervention. There was no restriction of a group that influenced the outcome, except the clinicians working on so many patients. Therefore fatigue might have affected the outcome. The rest of the result remained the same, including pay, choice of treatment and mode of treatment. There could be measurement bias on the part of the intervention group as each group was comfortable until intervention group that applied both the two intervention. They came back for frequent diagnoses (Little et al., 2015). This, therefore, recommends that for future use potential and further research should be done. The result was affected by particular limitation but of negligible units. The number of clinicians available was very few to prescribe and take a keen prescription for the individual. This limits generalizability and accuracy. The result that was dependent on variable factors could be difficult to compare. This factors that range from the environment, billing data and EHR, which might at some point affected the general measurement. The safety analyses were only based on the people who came back to the clinical organization. There could be people who went into other clinics or stayed at home but got harms (Cabral, Lucas, Ingram, Hay Horwood, 2015). In conclusion, the method used for intervention can be used to control inappropriate antibiotic for respiratory tract infection based on behavioral interventions. References Cabral, C., Lucas, P. J., Ingram, J., Hay, A. D., Horwood, J. (2015). It's safer to parent consulting and clinician antibiotic prescribing decisions for children with respiratory tract infections: an analysis across four qualitative studies.Social science medicine,136, 156-164. Dekker, A. R., Verheij, T. J., Broekhuizen, B. D., Butler, C. C., Cals, J. W., Francis, N. A., ... van der Velden, A. W. (2018). Effectiveness of general practitioner online training and an information booklet for parents on antibiotic prescribing for children with respiratory tract infection in primary care: a cluster randomized controlled trial.Journal of Antimicrobial Chemotherapy. Harris, A. M., Hicks, L. A., Qaseem, A. (2016). Appropriate antibiotic use for acute respiratory tract infection in adults: advice for high-value care from the American College of Physicians and the Centers for Disease Control and Prevention.Annals of internal medicine,164(6), 425-434. Hovi, T., Ollgren, J., Savolainen-Kopra, C. (2017). Intensified hand-hygiene campaign including soap-and-water wash may prevent acute infections in office workers, as shown by a recognized-exposure-adjusted analysis of a randomized trial.BMC infectious diseases,17(1), 47. Kotwani, A., Joshi, P. C., Jhamb, U., Holloway, K. (2017). Prescriber and dispenser perceptions about antibiotic use in acute uncomplicated childhood diarrhea and upper respiratory tract infection in New Delhi: Qualitative study.Indian Journal of Pharmacology,49(6), 419. Lee, M. H. M., Pan, D. S. T., Huang, J. H., Mark, I., Chen, C., Chong, J. W. C., ... Wong, C. S. (2017). Results from a patient-based health education intervention in reducing antibiotic use for acute upper respiratory tract infections in the private sector primary care setting in Singapore.Antimicrobial agents and chemotherapy,61(5), e02257-16. Little, P., Stuart, B., Hobbs, F. D. R., Moore, M., Barnett, J., Popoola, D., ... Yao, G. (2015). An internet-delivered handwashing intervention to modify influenza-like illness and respiratory infection transmission (PRIMIT): a primary care randomised trial.The Lancet,386(10004), 1631-1639. Meeker, D., Linder, J. A., Fox, C. R., Friedberg, M. W., Persell, S. D., Goldstein, N. J., ... Doctor, J. N. (2016). Effect of behavioral interventions on inappropriate antibiotic prescribing among primary care practices: a randomized clinical trial.Jama,315(6), 562-570.
Posted by Phillip Perkins at 4:01 AM