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1845. Implementing Outpatient Antimicrobial Stewardship in a Primary Care Office Through Pharmacist-led Audit and Feedback

BACKGROUND: More than 30% of antibiotics prescribed in the outpatient setting are unnecessary. This study aimed to determine the impact of pharmacist-led audit and feedback on outpatient antibiotic prescribing for upper respiratory tract infections (URIs) and urinary tract infections (UTIs). METHODS...

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Autores principales: Burns, Kayla, Pham, Selena, Dumkow, Lisa, Egwuatu, Nnaemeka
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6252860/
http://dx.doi.org/10.1093/ofid/ofy210.1501
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author Burns, Kayla
Pham, Selena
Dumkow, Lisa
Egwuatu, Nnaemeka
author_facet Burns, Kayla
Pham, Selena
Dumkow, Lisa
Egwuatu, Nnaemeka
author_sort Burns, Kayla
collection PubMed
description BACKGROUND: More than 30% of antibiotics prescribed in the outpatient setting are unnecessary. This study aimed to determine the impact of pharmacist-led audit and feedback on outpatient antibiotic prescribing for upper respiratory tract infections (URIs) and urinary tract infections (UTIs). METHODS: A retrospective, observational study was conducted at an outpatient primary care office to evaluate implementation of a pharmacist-led audit and feedback process. The office includes 0.6 FTE ambulatory care pharmacist (ACP) who completed antimicrobial stewardship training, and is part of a health system supported by a pharmacist and physician co-led antimicrobial stewardship program (ASP). Education, including pocket cards with URI and UTI guidelines was provided by the ASP leads in July 2017 prior to the study period (August 2017–March 2018). The ACP was responsible for weekly audit of all prescribed antibiotics for URI and UTI and provided feedback to prescribers. Appropriateness of therapy was determined via the guidelines presented by the ASP team. Feedback included recommendations regarding watch-and-wait, antimicrobial selection, dose, and duration of therapy. The primary outcome was to compare antibiotic use over time following the implementation of the audit and feedback program. RESULTS: Over the study period 1,107 prescriptions were audited by the ACP: 825 URI and 282 UTI. Feedback was provided for all cases, positive feedback for 580 (52.4%), negative feedback for 380, (34.3%) and mixed feedback for 147 (13.3%). The most common reasons for feedback were inappropriate agent (26.3%) and too long of duration of therapy (24.3%). Fluoroquinolone prescribing rates for UTIs decreased from 85% at baseline to 40% in Month 1 and to 11.7% of UTI prescriptions over the next 6 months. Nitrofurantoin prescribing increased from 0.4% in Month 1 to 38.6% of UTI prescriptions over the next 6 months to become the most commonly prescribed agent. Β-lactams were the most commonly prescribed antibiotics for URIs (66.7%). The median URI duration of therapy decreased from 10 days at baseline to 7 days across all 7 study months. CONCLUSION: Pharmacist-led audit and feedback significantly reduced fluoroquinolone prescribing for UTIs and shortened median duration of therapy for URIs in the outpatient setting. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-62528602018-11-28 1845. Implementing Outpatient Antimicrobial Stewardship in a Primary Care Office Through Pharmacist-led Audit and Feedback Burns, Kayla Pham, Selena Dumkow, Lisa Egwuatu, Nnaemeka Open Forum Infect Dis Abstracts BACKGROUND: More than 30% of antibiotics prescribed in the outpatient setting are unnecessary. This study aimed to determine the impact of pharmacist-led audit and feedback on outpatient antibiotic prescribing for upper respiratory tract infections (URIs) and urinary tract infections (UTIs). METHODS: A retrospective, observational study was conducted at an outpatient primary care office to evaluate implementation of a pharmacist-led audit and feedback process. The office includes 0.6 FTE ambulatory care pharmacist (ACP) who completed antimicrobial stewardship training, and is part of a health system supported by a pharmacist and physician co-led antimicrobial stewardship program (ASP). Education, including pocket cards with URI and UTI guidelines was provided by the ASP leads in July 2017 prior to the study period (August 2017–March 2018). The ACP was responsible for weekly audit of all prescribed antibiotics for URI and UTI and provided feedback to prescribers. Appropriateness of therapy was determined via the guidelines presented by the ASP team. Feedback included recommendations regarding watch-and-wait, antimicrobial selection, dose, and duration of therapy. The primary outcome was to compare antibiotic use over time following the implementation of the audit and feedback program. RESULTS: Over the study period 1,107 prescriptions were audited by the ACP: 825 URI and 282 UTI. Feedback was provided for all cases, positive feedback for 580 (52.4%), negative feedback for 380, (34.3%) and mixed feedback for 147 (13.3%). The most common reasons for feedback were inappropriate agent (26.3%) and too long of duration of therapy (24.3%). Fluoroquinolone prescribing rates for UTIs decreased from 85% at baseline to 40% in Month 1 and to 11.7% of UTI prescriptions over the next 6 months. Nitrofurantoin prescribing increased from 0.4% in Month 1 to 38.6% of UTI prescriptions over the next 6 months to become the most commonly prescribed agent. Β-lactams were the most commonly prescribed antibiotics for URIs (66.7%). The median URI duration of therapy decreased from 10 days at baseline to 7 days across all 7 study months. CONCLUSION: Pharmacist-led audit and feedback significantly reduced fluoroquinolone prescribing for UTIs and shortened median duration of therapy for URIs in the outpatient setting. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2018-11-26 /pmc/articles/PMC6252860/ http://dx.doi.org/10.1093/ofid/ofy210.1501 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Burns, Kayla
Pham, Selena
Dumkow, Lisa
Egwuatu, Nnaemeka
1845. Implementing Outpatient Antimicrobial Stewardship in a Primary Care Office Through Pharmacist-led Audit and Feedback
title 1845. Implementing Outpatient Antimicrobial Stewardship in a Primary Care Office Through Pharmacist-led Audit and Feedback
title_full 1845. Implementing Outpatient Antimicrobial Stewardship in a Primary Care Office Through Pharmacist-led Audit and Feedback
title_fullStr 1845. Implementing Outpatient Antimicrobial Stewardship in a Primary Care Office Through Pharmacist-led Audit and Feedback
title_full_unstemmed 1845. Implementing Outpatient Antimicrobial Stewardship in a Primary Care Office Through Pharmacist-led Audit and Feedback
title_short 1845. Implementing Outpatient Antimicrobial Stewardship in a Primary Care Office Through Pharmacist-led Audit and Feedback
title_sort 1845. implementing outpatient antimicrobial stewardship in a primary care office through pharmacist-led audit and feedback
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6252860/
http://dx.doi.org/10.1093/ofid/ofy210.1501
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