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Implementation of an Antibiotic Stewardship Initiative in a Large Urgent Care Network

IMPORTANCE: Urgent Care (UC) encounters result in more inappropriate antibiotic prescriptions than other outpatient setting. Few stewardship interventions have focused on UC. OBJECTIVE: To evaluate the effectiveness of an antibiotic stewardship initiative to reduce antibiotic prescribing for respira...

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Autores principales: Stenehjem, Edward, Wallin, Anthony, Willis, Park, Kumar, Naresh, Seibert, Allan M., Buckel, Whitney R., Stanfield, Valoree, Brunisholz, Kimberly D., Fino, Nora, Samore, Matthew H., Srivastava, Rajendu, Hicks, Lauri A., Hersh, Adam L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10176123/
https://www.ncbi.nlm.nih.gov/pubmed/37166794
http://dx.doi.org/10.1001/jamanetworkopen.2023.13011
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author Stenehjem, Edward
Wallin, Anthony
Willis, Park
Kumar, Naresh
Seibert, Allan M.
Buckel, Whitney R.
Stanfield, Valoree
Brunisholz, Kimberly D.
Fino, Nora
Samore, Matthew H.
Srivastava, Rajendu
Hicks, Lauri A.
Hersh, Adam L.
author_facet Stenehjem, Edward
Wallin, Anthony
Willis, Park
Kumar, Naresh
Seibert, Allan M.
Buckel, Whitney R.
Stanfield, Valoree
Brunisholz, Kimberly D.
Fino, Nora
Samore, Matthew H.
Srivastava, Rajendu
Hicks, Lauri A.
Hersh, Adam L.
author_sort Stenehjem, Edward
collection PubMed
description IMPORTANCE: Urgent Care (UC) encounters result in more inappropriate antibiotic prescriptions than other outpatient setting. Few stewardship interventions have focused on UC. OBJECTIVE: To evaluate the effectiveness of an antibiotic stewardship initiative to reduce antibiotic prescribing for respiratory conditions in a UC network. DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study conducted in a UC network with 38 UC clinics and 1 telemedicine clinic included 493 724 total UC encounters. The study compared the antibiotic prescribing rates of all UC clinicians who encountered respiratory conditions for a 12-month baseline period (July 1, 2018, through June 30, 2019) with an intervention period (July 1, 2019, through June 30, 2020). A sustainability period (July 1, 2020, through June 30, 2021) was added post hoc. INTERVENTIONS: Stewardship interventions included (1) education for clinicians and patients, (2) electronic health record (EHR) tools, (3) a transparent clinician benchmarking dashboard, and (4) media. Occurring independently but concurrent with the interventions, a stewardship measure was introduced by UC leadership into the quality measures, including a financial incentive. MAIN OUTCOMES AND MEASURES: The primary outcome was the percentage of UC encounters with an antibiotic prescription for a respiratory condition. Secondary outcomes included antibiotic prescribing when antibiotics were not indicated (tier 3 encounters) and first-line antibiotics for acute otitis media, sinusitis, and pharyngitis. Interrupted time series with binomial generalized estimating equations were used to compare periods. RESULTS: The baseline period included 207 047 UC encounters for respiratory conditions (56.8% female; mean [SD] age, 30.0 [21.4] years; 92.0% White race); the intervention period included 183 893 UC encounters (56.4% female; mean [SD] age, 30.7 [20.8] years; 91.2% White race). Antibiotic prescribing for respiratory conditions decreased from 47.8% (baseline) to 33.3% (intervention). During the initial intervention month, a 22% reduction in antibiotic prescribing occurred (odds ratio [OR], 0.78; 95% CI, 0.71-0.86). Antibiotic prescriptions decreased by 5% monthly during the intervention (OR, 0.95; 95% CI, 0.94-0.96). Antibiotic prescribing for tier 3 encounters decreased by 47% (OR, 0.53; 95% CI, 0.44-63), and first-line antibiotic prescriptions increased by 18% (OR, 1.18; 95% CI, 1.09-1.29) during the initial intervention month. Antibiotic prescriptions for tier 3 encounters decreased by an additional 4% each month (OR, 0.96; 95% CI, 0.94-0.98), whereas first-line antibiotic prescriptions did not change (OR, 1.00; 95% CI, 0.99-1.01). Antibiotic prescribing for respiratory conditions remained stable in the sustainability period. CONCLUSIONS AND RELEVANCE: The findings of this quality improvement study indicated that a UC antibiotic stewardship initiative was associated with decreased antibiotic prescribing for respiratory conditions. This study provides a model for UC antibiotic stewardship.
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spelling pubmed-101761232023-05-13 Implementation of an Antibiotic Stewardship Initiative in a Large Urgent Care Network Stenehjem, Edward Wallin, Anthony Willis, Park Kumar, Naresh Seibert, Allan M. Buckel, Whitney R. Stanfield, Valoree Brunisholz, Kimberly D. Fino, Nora Samore, Matthew H. Srivastava, Rajendu Hicks, Lauri A. Hersh, Adam L. JAMA Netw Open Original Investigation IMPORTANCE: Urgent Care (UC) encounters result in more inappropriate antibiotic prescriptions than other outpatient setting. Few stewardship interventions have focused on UC. OBJECTIVE: To evaluate the effectiveness of an antibiotic stewardship initiative to reduce antibiotic prescribing for respiratory conditions in a UC network. DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study conducted in a UC network with 38 UC clinics and 1 telemedicine clinic included 493 724 total UC encounters. The study compared the antibiotic prescribing rates of all UC clinicians who encountered respiratory conditions for a 12-month baseline period (July 1, 2018, through June 30, 2019) with an intervention period (July 1, 2019, through June 30, 2020). A sustainability period (July 1, 2020, through June 30, 2021) was added post hoc. INTERVENTIONS: Stewardship interventions included (1) education for clinicians and patients, (2) electronic health record (EHR) tools, (3) a transparent clinician benchmarking dashboard, and (4) media. Occurring independently but concurrent with the interventions, a stewardship measure was introduced by UC leadership into the quality measures, including a financial incentive. MAIN OUTCOMES AND MEASURES: The primary outcome was the percentage of UC encounters with an antibiotic prescription for a respiratory condition. Secondary outcomes included antibiotic prescribing when antibiotics were not indicated (tier 3 encounters) and first-line antibiotics for acute otitis media, sinusitis, and pharyngitis. Interrupted time series with binomial generalized estimating equations were used to compare periods. RESULTS: The baseline period included 207 047 UC encounters for respiratory conditions (56.8% female; mean [SD] age, 30.0 [21.4] years; 92.0% White race); the intervention period included 183 893 UC encounters (56.4% female; mean [SD] age, 30.7 [20.8] years; 91.2% White race). Antibiotic prescribing for respiratory conditions decreased from 47.8% (baseline) to 33.3% (intervention). During the initial intervention month, a 22% reduction in antibiotic prescribing occurred (odds ratio [OR], 0.78; 95% CI, 0.71-0.86). Antibiotic prescriptions decreased by 5% monthly during the intervention (OR, 0.95; 95% CI, 0.94-0.96). Antibiotic prescribing for tier 3 encounters decreased by 47% (OR, 0.53; 95% CI, 0.44-63), and first-line antibiotic prescriptions increased by 18% (OR, 1.18; 95% CI, 1.09-1.29) during the initial intervention month. Antibiotic prescriptions for tier 3 encounters decreased by an additional 4% each month (OR, 0.96; 95% CI, 0.94-0.98), whereas first-line antibiotic prescriptions did not change (OR, 1.00; 95% CI, 0.99-1.01). Antibiotic prescribing for respiratory conditions remained stable in the sustainability period. CONCLUSIONS AND RELEVANCE: The findings of this quality improvement study indicated that a UC antibiotic stewardship initiative was associated with decreased antibiotic prescribing for respiratory conditions. This study provides a model for UC antibiotic stewardship. American Medical Association 2023-05-11 /pmc/articles/PMC10176123/ /pubmed/37166794 http://dx.doi.org/10.1001/jamanetworkopen.2023.13011 Text en Copyright 2023 Stenehjem E et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Stenehjem, Edward
Wallin, Anthony
Willis, Park
Kumar, Naresh
Seibert, Allan M.
Buckel, Whitney R.
Stanfield, Valoree
Brunisholz, Kimberly D.
Fino, Nora
Samore, Matthew H.
Srivastava, Rajendu
Hicks, Lauri A.
Hersh, Adam L.
Implementation of an Antibiotic Stewardship Initiative in a Large Urgent Care Network
title Implementation of an Antibiotic Stewardship Initiative in a Large Urgent Care Network
title_full Implementation of an Antibiotic Stewardship Initiative in a Large Urgent Care Network
title_fullStr Implementation of an Antibiotic Stewardship Initiative in a Large Urgent Care Network
title_full_unstemmed Implementation of an Antibiotic Stewardship Initiative in a Large Urgent Care Network
title_short Implementation of an Antibiotic Stewardship Initiative in a Large Urgent Care Network
title_sort implementation of an antibiotic stewardship initiative in a large urgent care network
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10176123/
https://www.ncbi.nlm.nih.gov/pubmed/37166794
http://dx.doi.org/10.1001/jamanetworkopen.2023.13011
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