Improving Antibiotic Use in Acute Care Treatment
IMPAACT
2 other identifiers
interventional
1,000
1 country
9
Brief Summary
Purpose The emergence and rapid rise in antibiotic resistance among common bacteria are adversely affecting the clinical course and health care costs of community-acquired infections. Because antibiotic resistance rates are strongly correlated with antibiotic use patterns, multiple organizations have declared reductions in unnecessary antibiotic use to be critical components of efforts to combat antibiotic resistance. Among humans, the vast majority of unnecessary antibiotic prescriptions are used to treat acute respiratory tract infections (ARIs) that have a viral etiology. Although the rate of antibiotic prescribing for ARIs by office-based physicians in the US has decreased about 16% from its peak in 1997, the rate of antibiotic prescribing in acute care settings (eg, emergency departments and urgent care centers), which account for 1 in 5 ambulatory antibiotic prescriptions in the US, has shown only a modest decline (6%) during this period. Translation of lessons from intervention studies in office-based practices is needed to improve antibiotic use in acute care settings.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for not_applicable
Started Feb 2004
Longer than P75 for not_applicable
9 active sites
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
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Study Timeline
Key milestones and dates
Study Start
First participant enrolled
February 1, 2004
CompletedFirst Submitted
Initial submission to the registry
August 31, 2005
CompletedFirst Posted
Study publicly available on registry
September 2, 2005
CompletedStudy Completion
Last participant's last visit for all outcomes
July 1, 2007
CompletedApril 7, 2015
April 1, 2015
August 31, 2005
April 6, 2015
Conditions
Keywords
Outcome Measures
Primary Outcomes (1)
Proportion of all acute respiratory infection visits treated with antibiotics
Secondary Outcomes (1)
Delayed antibiotic treatment of acute respiratory infections; Patient satisfaction
Study Arms (1)
Arm 1
OTHERInterventions
Eligibility Criteria
You may qualify if:
- Emergency room patient
- Selected VA or Non-VA patients
- Age 18 years or older
- Patient must have acute respiratory illness
- Patient must not have been seen in Emergency Department within 4 weeks
You may not qualify if:
- Patients less than 18 years of age
- Patient in Emergency Department for non-acute respiratory infection
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (9)
VA San Diego Healthcare System, San Diego, CA
San Diego, California, 92161, United States
Charlie Norwood VA Medical Center, Augusta, GA
Augusta, Georgia, 30904, United States
Edward Hines Jr. VA Hospital, Hines, IL
Hines, Illinois, 60141-5000, United States
Kansas City VA Medical Center, Kansas City, MO
Kansas City, Missouri, 64128, United States
New Mexico VA Health Care System, Albuquerque, NM
Albuquerque, New Mexico, 87108-5153, United States
James J. Peters VA Medical Center, Bronx, NY
The Bronx, New York, 10468, United States
Philadelphia VA Medical Center, Philadelphia, PA
Philadelphia, Pennsylvania, 19104, United States
VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA
Pittsburgh, Pennsylvania, 15240, United States
South Texas Health Care System, San Antonio, TX
San Antonio, Texas, 78229, United States
Related Publications (7)
Metlay JP, Camargo CA Jr, Bos K, Gonzales R. Assessing the suitability of intervention sites for quality improvement studies in emergency departments. Acad Emerg Med. 2005 Jul;12(7):667-70. doi: 10.1197/j.aem.2005.01.012.
PMID: 15995102RESULTGonzales R, Camargo CA Jr, MacKenzie T, Kersey AS, Maselli J, Levin SK, McCulloch CE, Metlay JP; IMPAACT Trial Investigators. Antibiotic treatment of acute respiratory infections in acute care settings. Acad Emerg Med. 2006 Mar;13(3):288-94. doi: 10.1197/j.aem.2005.10.016.
PMID: 16514122RESULTVanderweil SG, Pelletier AJ, Hamedani AG, Gonzales R, Metlay JP, Camargo CA Jr. Declining antibiotic prescriptions for upper respiratory infections, 1993-2004. Acad Emerg Med. 2007 Apr;14(4):366-9. doi: 10.1197/j.aem.2006.10.096. Epub 2007 Feb 12.
PMID: 17296803RESULTAspinall SL, Metlay JP, Maselli JH, Gonzales R. Impact of hospital formularies on fluoroquinolone prescribing in emergency departments. Am J Manag Care. 2007 May;13(5):241-8.
PMID: 17488189RESULTMetlay JP, Camargo CA Jr, MacKenzie T, McCulloch C, Maselli J, Levin SK, Kersey A, Gonzales R; IMPAACT Investigators. Cluster-randomized trial to improve antibiotic use for adults with acute respiratory infections treated in emergency departments. Ann Emerg Med. 2007 Sep;50(3):221-30. doi: 10.1016/j.annemergmed.2007.03.022. Epub 2007 May 23.
PMID: 17509729RESULTNolt BR, Gonzales R, Maselli J, Aagaard E, Camargo CA Jr, Metlay JP. Vital-sign abnormalities as predictors of pneumonia in adults with acute cough illness. Am J Emerg Med. 2007 Jul;25(6):631-6. doi: 10.1016/j.ajem.2006.11.031.
PMID: 17606087RESULTPines JM, Hollander JE, Lee H, Everett WW, Uscher-Pines L, Metlay JP. Emergency department operational changes in response to pay-for-performance and antibiotic timing in pneumonia. Acad Emerg Med. 2007 Jun;14(6):545-8. doi: 10.1197/j.aem.2007.01.022. Epub 2007 Apr 30.
PMID: 17470905RESULT
MeSH Terms
Conditions
Interventions
Condition Hierarchy (Ancestors)
Intervention Hierarchy (Ancestors)
Study Officials
- PRINCIPAL INVESTIGATOR
Joshua P. Metlay, MD PhD
Philadelphia VA Medical Center, Philadelphia, PA
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- RANDOMIZED
- Masking
- NONE
- Intervention Model
- FACTORIAL
- Sponsor Type
- FED
- Responsible Party
- SPONSOR
Study Record Dates
First Submitted
August 31, 2005
First Posted
September 2, 2005
Study Start
February 1, 2004
Study Completion
July 1, 2007
Last Updated
April 7, 2015
Record last verified: 2015-04