TY  - JOUR
AU  - Attal, Hersh
AU  - Huang, Zhilian
AU  - Kuan, Win Sen
AU  - Weng, Yanyi
AU  - Tan, Hann Yee
AU  - Seow, Eillyne
AU  - Peng, Li Lee
AU  - Lim, Hoon Chin
AU  - Chow, Angela
PY  - 2024
DA  - 2024/2/21
TI  - N-of-1 Trials of Antimicrobial Stewardship Interventions to Optimize Antibiotic Prescribing for Upper Respiratory Tract Infection in Emergency Departments: Protocol for a Quasi-Experimental Study
JO  - JMIR Res Protoc
SP  - e50417
VL  - 13
KW  - antibiotic resistance
KW  - emergency department
KW  - upper respiratory tract infection
KW  - N-of-1 trials
KW  - prescribing feedback
KW  - feedback
KW  - emergency
KW  - upper respiratory tract
KW  - respiratory
KW  - antibiotic
KW  - antimicrobial stewardship
KW  - antimicrobials
KW  - antibiotics
KW  - hospital
KW  - experimental study
KW  - antibiotic therapy
KW  - URTI
KW  - evidence-based intervention
KW  - evidence-based
KW  - patient education
KW  - prescribing rates
KW  - patient literacy
KW  - Singapore
KW  - regression analysis
KW  - regression
AB  - Background: Antimicrobial stewardship programs attempting to optimize antibiotic therapy and clinical outcomes mainly focus on inpatient and outpatient settings. The lack of antimicrobial stewardship program studies in the emergency department (ED) represents a gap in tackling the problem of antimicrobial resistance as EDs treat a substantial number of upper respiratory tract infection cases throughout the year. Objective: We intend to implement two evidence-based interventions: (1) patient education and (2) providing physician feedback on their prescribing rates. We will incorporate evidence from a literature review and contextualizing the interventions based on findings from a local qualitative study. Methods: Our study uses a quasi-experimental design to evaluate the effects of interventions over time in the EDs of 4 public hospitals in Singapore. We will include an initial control period of 18 months. In the next 6 months, we will randomize 2 EDs to receive 1 intervention (ie, patient education) and the other 2 EDs to receive the alternative intervention (ie, physician feedback). All EDs will receive the second intervention in the subsequent 6 months on top of the ongoing intervention. Data will be collected for another 6 months to assess the persistence of the intervention effects. The information leaflets will be handed to patients at the EDs before they consult with the physician, while feedback to individual physicians by senior doctors is in the form of electronic text messages. The feedback will contain the physicians’ antibiotic prescribing rate compared with the departments’ overall antibiotic prescribing rate and a bite-size message on good antibiotic prescribing practices. Results: We will analyze the data using segmented regression with difference-in-difference estimation to account for concurrent cluster comparisons. Conclusions: Our proposed study assesses the effectiveness of evidence-based, context-specific interventions to optimize antibiotic prescribing in EDs. These interventions are aligned with Singapore’s national effort to tackle antimicrobial resistance and can be scaled up if successful. Trial Registration: ClinicalTrials.gov NCT05451863; https://clinicaltrials.gov/study/NCT05451836 International Registered Report Identifier (IRRID): DERR1-10.2196/50417 
SN  - 1929-0748
UR  - https://www.researchprotocols.org/2024/1/e50417
UR  - https://doi.org/10.2196/50417
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38381495
DO  - 10.2196/50417
ID  - info:doi/10.2196/50417
ER  -