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208. Trends in Antibiotic Prescribing for Acute Respiratory Tract Infections and Implementation of a Provider-Directed Intervention Within the Veterans Affairs Healthcare System (VA)

BACKGROUND: We report VA-wide trends over time in acute respiratory infection (ARI) antibiotic prescribing, and early assessment of an intervention to improve ARI management. METHODS: We created a retrospective cohort of ARI (sinusitis, pharyngitis, bronchitis, and URI-NOS) visits between 2009 and A...

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Autores principales: Madaras-Kelly, Karl, Hruza, Hayli, Pontefract, Benjamin, Jones, Barbara, Jones, Makoto, Yao, Yiwen, Nevers, McKenna, Ying, Jian, Haaland, Ben, Kay, Chad, Christopher, Melissa, Samore, Matthew
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254223/
http://dx.doi.org/10.1093/ofid/ofy210.221
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author Madaras-Kelly, Karl
Hruza, Hayli
Pontefract, Benjamin
Jones, Barbara
Jones, Makoto
Yao, Yiwen
Nevers, McKenna
Ying, Jian
Haaland, Ben
Kay, Chad
Christopher, Melissa
Samore, Matthew
author_facet Madaras-Kelly, Karl
Hruza, Hayli
Pontefract, Benjamin
Jones, Barbara
Jones, Makoto
Yao, Yiwen
Nevers, McKenna
Ying, Jian
Haaland, Ben
Kay, Chad
Christopher, Melissa
Samore, Matthew
author_sort Madaras-Kelly, Karl
collection PubMed
description BACKGROUND: We report VA-wide trends over time in acute respiratory infection (ARI) antibiotic prescribing, and early assessment of an intervention to improve ARI management. METHODS: We created a retrospective cohort of ARI (sinusitis, pharyngitis, bronchitis, and URI-NOS) visits between 2009 and April 2018. Patients with complicating conditions were excluded. Antibiotic prescribing rates were calculated. A provider-directed VA-wide ARI campaign was initiated in October 2017. The Campaign was implemented locally by antibiotic stewards or regional personnel trained in academic detailing (AD). Campaign components: dashboards for tracking provider and facility prescribing metrics, printable feedback reports, and AD educational materials. Metrics include: ARI antibiotic prescribing rates, bronchitis/URI-NOS antibiotic prescribing rates, guideline-concordant antibiotic selection for sinusitis or pharyngitis, and proportion of ARI visits with a sinusitis diagnosis. A Logistic generalized estimating equation model assessed metrics over time pre-/postintervention and χ(2) tests compared guideline concordant antibiotic proportions pre-/postintervention. RESULTS: There were 1,580,612 and 137,421 ARI visits pre-/postintervention, respectively. Antibiotic prescribing decreased from 2009, annual odds ratio (OR) 0.94 [95% CI 0.93, 0.96; P < 0.001]. An additional effect was observed postintervention [OR 0.88, (0.84, 0.88), P < 0.001]. Bronchitis/URI-NOS prescribing rates decreased from 2009 [annual OR 0.94 (CI 0.93, 0.95), P < 0.001]. Additional effect was observed postintervention [OR 0.86, (0.81, 0.91), P < 0.001]. Overall, the proportion of ARI visits diagnosed with sinusitis increased [annual OR 1.09 (1.08, 1.10), P < 0.01], but the proportion of sinusitis diagnoses decreased [OR 0.72 (0.69, 0.75), P < 0.001] postintervention. Guideline-concordant antibiotic selection was 61.5% vs. 71.2% for sinusitis and 63.3% vs. 67.8% for pharyngitis pre-/postintervention, respectively (both P < 0.001). CONCLUSION: Antibiotic prescribing rates for ARIs within the VA have steadily declined since 2010. Additional decline in antibiotic prescribing was associated with the launch of a national campaign to improve ARI management. [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-62542232018-11-28 208. Trends in Antibiotic Prescribing for Acute Respiratory Tract Infections and Implementation of a Provider-Directed Intervention Within the Veterans Affairs Healthcare System (VA) Madaras-Kelly, Karl Hruza, Hayli Pontefract, Benjamin Jones, Barbara Jones, Makoto Yao, Yiwen Nevers, McKenna Ying, Jian Haaland, Ben Kay, Chad Christopher, Melissa Samore, Matthew Open Forum Infect Dis Abstracts BACKGROUND: We report VA-wide trends over time in acute respiratory infection (ARI) antibiotic prescribing, and early assessment of an intervention to improve ARI management. METHODS: We created a retrospective cohort of ARI (sinusitis, pharyngitis, bronchitis, and URI-NOS) visits between 2009 and April 2018. Patients with complicating conditions were excluded. Antibiotic prescribing rates were calculated. A provider-directed VA-wide ARI campaign was initiated in October 2017. The Campaign was implemented locally by antibiotic stewards or regional personnel trained in academic detailing (AD). Campaign components: dashboards for tracking provider and facility prescribing metrics, printable feedback reports, and AD educational materials. Metrics include: ARI antibiotic prescribing rates, bronchitis/URI-NOS antibiotic prescribing rates, guideline-concordant antibiotic selection for sinusitis or pharyngitis, and proportion of ARI visits with a sinusitis diagnosis. A Logistic generalized estimating equation model assessed metrics over time pre-/postintervention and χ(2) tests compared guideline concordant antibiotic proportions pre-/postintervention. RESULTS: There were 1,580,612 and 137,421 ARI visits pre-/postintervention, respectively. Antibiotic prescribing decreased from 2009, annual odds ratio (OR) 0.94 [95% CI 0.93, 0.96; P < 0.001]. An additional effect was observed postintervention [OR 0.88, (0.84, 0.88), P < 0.001]. Bronchitis/URI-NOS prescribing rates decreased from 2009 [annual OR 0.94 (CI 0.93, 0.95), P < 0.001]. Additional effect was observed postintervention [OR 0.86, (0.81, 0.91), P < 0.001]. Overall, the proportion of ARI visits diagnosed with sinusitis increased [annual OR 1.09 (1.08, 1.10), P < 0.01], but the proportion of sinusitis diagnoses decreased [OR 0.72 (0.69, 0.75), P < 0.001] postintervention. Guideline-concordant antibiotic selection was 61.5% vs. 71.2% for sinusitis and 63.3% vs. 67.8% for pharyngitis pre-/postintervention, respectively (both P < 0.001). CONCLUSION: Antibiotic prescribing rates for ARIs within the VA have steadily declined since 2010. Additional decline in antibiotic prescribing was associated with the launch of a national campaign to improve ARI management. [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2018-11-26 /pmc/articles/PMC6254223/ http://dx.doi.org/10.1093/ofid/ofy210.221 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
Madaras-Kelly, Karl
Hruza, Hayli
Pontefract, Benjamin
Jones, Barbara
Jones, Makoto
Yao, Yiwen
Nevers, McKenna
Ying, Jian
Haaland, Ben
Kay, Chad
Christopher, Melissa
Samore, Matthew
208. Trends in Antibiotic Prescribing for Acute Respiratory Tract Infections and Implementation of a Provider-Directed Intervention Within the Veterans Affairs Healthcare System (VA)
title 208. Trends in Antibiotic Prescribing for Acute Respiratory Tract Infections and Implementation of a Provider-Directed Intervention Within the Veterans Affairs Healthcare System (VA)
title_full 208. Trends in Antibiotic Prescribing for Acute Respiratory Tract Infections and Implementation of a Provider-Directed Intervention Within the Veterans Affairs Healthcare System (VA)
title_fullStr 208. Trends in Antibiotic Prescribing for Acute Respiratory Tract Infections and Implementation of a Provider-Directed Intervention Within the Veterans Affairs Healthcare System (VA)
title_full_unstemmed 208. Trends in Antibiotic Prescribing for Acute Respiratory Tract Infections and Implementation of a Provider-Directed Intervention Within the Veterans Affairs Healthcare System (VA)
title_short 208. Trends in Antibiotic Prescribing for Acute Respiratory Tract Infections and Implementation of a Provider-Directed Intervention Within the Veterans Affairs Healthcare System (VA)
title_sort 208. trends in antibiotic prescribing for acute respiratory tract infections and implementation of a provider-directed intervention within the veterans affairs healthcare system (va)
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254223/
http://dx.doi.org/10.1093/ofid/ofy210.221
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