More recently, Davis and Taylor-Vaisey proposed that to be successfully implemented, any guideline must include strategies to facilitate its adoption. The nature of the guideline, the nature and beliefs of the physicians to whom it is directed, and environmental factors should all be considered to translate effectively clinical guidelines into practice. There appears to be two important steps: the effective dissemination of the information and the effective implementation strategies that reinforce changes in the practice setting. Although several interventions appear to be effective, strategies such as concurrent reminders or academic detailing have yielded the most consistently positive results.
In view of the above, any intervention or training program to improve the level of appropriateness of antimicrobial prescribing among military prescribers would need to incorporate both a reminder system and form an academic detailing to ensure that not only are prescribers aware of the guidelines, but that they actually put this knowledge into practice. This would presumably improve patient outcome, cost of therapy and prevent the emergence of antimicrobial resistance. Because physician assistants were involved more frequently in partial compliance, this group should be targeted first.
The majority of prescriptions evaluated in this DUE met the criteria for compliance or partial compliance with the treatment recommendations. The rates of compliance (which included partial compliance) between physician assitants and general practitioners were relatively similar, 86.2% and 85.3%, respectively. Yet, efforts should be made to ensure that antibiotics prescriptions written by military prescribers are effective against the causative agent, are prescribed at the recommended dose and duration of treatment and that first line agents are used whenever possible. Indeed, it has been recognized that reducing the unnecessary and inappropriate use of antibacteri-als can minimize the development of resistant strains. buy ortho tri-cyclen online
Because inappropriate use of anti-infective agents can lead to increased rates of bacterial resistance, strategies to disseminate and reinforce guidelines recommendations for the indications most frequently associated with either noncompliance or partial compliance should be developed.