179. A Passive, Prescriber-Directed, Electronic Alert Plus Prescriber Education Decreased Antibiotic Prescribing for Ambulatory Adults With Acute, Uncomplicated Bronchitis in a Large Integrated Health System

BACKGROUND: Antibiotics (ABX) are often prescribed for acute bronchitis (AB). Reducing inappropriate ambulatory ABX use is critical to combat ABX resistance and reduce ABX-related adverse events. We sought to determine the impact of a passive, prescriber-directed, electronic best practice alert (BPA) coupled with prescriber education on ABX prescribing for ambulatory adults with AB. METHODS: A retrospective, quasi-experimental study of adults with a primary diagnosis of AB discharged from any emergency department (ED), urgent care (UC), or ambulatory clinic (AC) within an integrated health system was performed. AB diagnosis codes triggered the BPA. An online continuing education course was created for prescribers. The preintervention period (PRE) was January 1, 2016–November 30, 2016 for UC and ED sites and January 1, 2016–September 28, 1017 for AC sites. The postintervention period (POST) was December 1, 2016–March 31, 2018 for UC and ED sites and September 29, 2017–March 31, 2018 for AC sites. The primary outcome was an ABX prescription targeting the upper respiratory tract. Patient- and prescriber-level data were collected. Forward stepwise multivariable (MV) logistic regression was used to determine predictors of ABX prescribing, with a P-value of < 0.05 for model entry. RESULTS: A total of 136,818 unique ambulatory adults had a primary diagnosis of AB. An 8.3% reduction in ABX prescribing for AB was observed (49,246 out of 79,299 patients [62.1%] pre- vs. 30,918 out of 57,519 patients [53.8%] post; P < 0.0001), corresponding to 3,652 less ABX prescriptions. ABX prescribing rates by setting are shown in Table 1 and Figure 1. In MV analysis, POST patients were less likely to receive ABX (aOR = 0.60, 95% CI = 0.58–0.62); however, patients who smoked or presented for a walk-in visit were more likely to receive ABX (aOR = 1.148, 95% CI = 1.11–1.19 and aOR = 1.45, 95% CI = 1.40–1.50, respectively). CONCLUSION: A passive, prescriber-directed, electronic BPA combined with education was associated with a statistically significant reduction in ABX prescribing for ambulatory adults with AB, particularly in the ED. DISCLOSURES: All authors: No reported disclosures.