[I'm sorry, faithful readers. It's the most compelling election of my voting lifetime. I'm riveted. Also, I spent hours in the ER Sunday getting stitched up from a bike crash. A very clean ER ... I hope.]
... an intriguing paper on controlling antibiotic prescribing within health care institutions.
Limiting inappropriate use of antibiotics is one of the central goals of the movement to control MRSA. Often, that's interpreted as getting primary-care docs and pediatricians to resist pressure from consumers, especially parents with busy lives who need to limit their sick child's illness so they can get back to work (or put the child back in day care) and stubbornly insist that antibiotics will help even when the illness is viral. But it's just as important, possibly more important, to control inappropriate use in hospitals, where sick patients with depleted immune systems who are getting lots of drugs provide a fertile breeding ground for resistant strains.
So how to do that? If possible, you want the intervention to be systematized, not exceptional; you want it to be a routine occurrence, so clinicians don't feel singled out for their prescribing choices, and you want it to be not face-to-face, so that the encounter remains about the patient and the drug, not about a clash of personalities.
A team at Johns Hopkins' children's hospital seems to have hit it whang in the gold. In the Sept. 15 issue of Clinical Infectious Diseases, Allison Agwu, Christoph Lehmann and colleagues describe a Web-based system that they instituted that significantly reduced inappropriate dosing and saved more than $370,000 in a year while making clinicians and pharmacists happier than they were with the previous system (which involved pagers and was face-to-face).
By chance, the Wall Street Journal ran a story this morning looking at such intervention programs, though not the Hopkins one — a story I missed because, in my normal reading time, I was interviewing Agwu and Lehmann. (H/t Joanne Kenen for alerting me to it though.)