Background: In diagnostic evaluation, it is necessary to assess the clinical impact of a new diagnostic as well as its diagnostic accuracy. The comparative interrupted time series design has been proposed as a quasi-experimental approach to evaluating interventions. We show how it can be used in the design of a study to evaluate a point-of-care diagnostic test for C-reactive protein in out-of-hours primary care services, to guide antibiotic prescribing among patients presenting with possible respiratory tract infection. This study consisted of a retrospective phase that used routinely collected monthly antibiotic prescribing data from different study sites, and a prospective phase in which antibiotic prescribing rates were monitored after the C-reactive protein diagnostic was introduced at some of the sites.
Methods: Of 8 study sites, 3 were assigned to receive the diagnostic and 5 were assigned as controls. We obtained retrospective monthly time series of respiratory tract targeted antibiotic prescriptions at each site. Separate ARIMA models at each site were used these to forecast monthly prescription counts that would be expected in the prospective phase, using simulation to obtain a set of 1-year predictions alongside their standard errors. We show how these forecasts can be combined to test for a change in prescription rates after introduction of the diagnostic and estimate power to detect this change.
Results: Fitted time series models at each site were stationary and showed second-order annual seasonality, with a clear December peak in prescriptions, although the timing and extent of the peak varied between sites and between years. Mean one-year predictions of antibiotic prescribing rates based on the retrospective time series analysis differed between sites assigned to receive the diagnostic and those assigned to control. Adjusting for the trend in the retrospective time series at each site removed these differences.
Conclusions: Quasi-experimental designs such as comparative interrupted time series can be used in diagnostic evaluation to estimate effect sizes before conducting a full randomised controlled trial or if a randomised trial is infeasible. In multi-site studies, existing retrospective data should be used to adjust for underlying differences between sites to make outcome data from different sites comparable, when possible.
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http://dx.doi.org/10.1186/s41512-022-00118-w | DOI Listing |
Infect Dis Poverty
January 2025
School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China.
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View Article and Find Full Text PDFJ Orthop Surg Res
January 2025
Excellence Center for Hip & Knee Arthroplasty, Department of Orthopedic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands.
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View Article and Find Full Text PDFBMC Public Health
January 2025
Reproductive Medicine Centre, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, 518035, China.
Background: Infertility is a widespread problem for couples worldwide, and lifestyle factors are the cornerstone of infertility prevention. This research seeks to explore the association between combined healthy lifestyles and infertility risk among women of reproductive age.
Methods: This study analyzed data from the National Health and Nutrition Examination Survey (NHANES, 2013-2018), concentrating on 2,154 women aged 18 to 44.
BMC Public Health
January 2025
Department of Health Management of Public Health, College of Public Health, Zhengzhou University, 100 Kexue Road, Gaoxin district, Zhengzhou, Henan, 450001, China.
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View Article and Find Full Text PDFBMC Public Health
January 2025
Department of Statistics, College of Natural and Computational Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia.
Backgrounds: Poverty is a complex and multifaceted global public health issue, particularly prevalent in Ethiopia, including the East Gojjam Zone. Previous studies on poverty have largely relied on unidimensional measures, providing limited evidence on multidimensional poverty (MP). Therefore, this study tried to assess the prevalence and identify the associated factors of MP among rural households in selected woredas of East Gojjam Zone, Northern Ethiopia.
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