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1813. Development and Validation of Novel Ambulatory Antibiotic Stewardship Metrics

BACKGROUND: Over 260 million antibiotic courses are prescribed in ambulatory settings per year in the United States: 41% of which are for acute respiratory tract infections (ARTI). Over 50% of these antibiotic courses are inappropriate. However, interventions to improve ambulatory prescribing are li...

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Autores principales: Hamilton, Keith W, Degnan, Kathleen O, Cluzet, Valerie, Cressman, Leigh, Adu-Gyamfi, Afia B, Tolomeo, Pam, David, Michael Z
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254525/
http://dx.doi.org/10.1093/ofid/ofy210.1469
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author Hamilton, Keith W
Degnan, Kathleen O
Cluzet, Valerie
Cressman, Leigh
Adu-Gyamfi, Afia B
Tolomeo, Pam
David, Michael Z
author_facet Hamilton, Keith W
Degnan, Kathleen O
Cluzet, Valerie
Cressman, Leigh
Adu-Gyamfi, Afia B
Tolomeo, Pam
David, Michael Z
author_sort Hamilton, Keith W
collection PubMed
description BACKGROUND: Over 260 million antibiotic courses are prescribed in ambulatory settings per year in the United States: 41% of which are for acute respiratory tract infections (ARTI). Over 50% of these antibiotic courses are inappropriate. However, interventions to improve ambulatory prescribing are little studied, and metrics to track antibiotic use are not well validated. METHODS: To validate metrics for ARTIs in adults, we conducted a retrospective cohort study from January 1, 2016 to December 31, 2016 at 32 primary care practices. We randomly selected 1,200 office visits with a coded respiratory tract diagnosis and determined by medical record review the proportion of visits in which antibiotic prescription was inappropriate using modified Infectious Diseases Society of America treatment guidelines. We determined clinic and provider characteristics associated with inappropriate prescribing. By linear regression, we also determined the aggregate metrics best correlated with inappropriate antibiotic prescribing. RESULTS: An antibiotic was prescribed in 37% of visits in which a respiratory tract diagnosis was coded. Of these prescriptions, 69% were inappropriate. Demographics associated with inappropriate prescribing included advance practice provider vs. physician (72% vs. 58%, P = 0.02), family medicine vs. internal medicine (75% vs. 63%, P = 0.01), board certification after vs. before 1997 (75% vs. 63%, P = 0.02), and practice in a non-teaching vs. teaching clinic (73% vs. 51%, P < 0.001). Rate of antibiotic prescribing in visits where any respiratory tract diagnosis was coded (R(2) = 0.23, P < 0.001) and rate of antibiotic prescribing in visits where a respiratory tract diagnosis that almost never requires an antibiotic was coded (R(2) = 0.24, P < 0.0001) were most strongly correlated with inappropriate prescribing. CONCLUSION: Rate of antibiotic prescribing in visits where any respiratory tract diagnosis was coded and rate of antibiotic prescribing in visits where a respiratory tract diagnosis that almost never requires an antibiotic was coded may be useful proxies to estimate the rate of inappropriate prescribing for ARTIs. This study could inform ambulatory antibiotic benchmarking metrics and interventions to decrease inappropriate antibiotic prescribing for ARTIs in ambulatory settings. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-62545252018-11-28 1813. Development and Validation of Novel Ambulatory Antibiotic Stewardship Metrics Hamilton, Keith W Degnan, Kathleen O Cluzet, Valerie Cressman, Leigh Adu-Gyamfi, Afia B Tolomeo, Pam David, Michael Z Open Forum Infect Dis Abstracts BACKGROUND: Over 260 million antibiotic courses are prescribed in ambulatory settings per year in the United States: 41% of which are for acute respiratory tract infections (ARTI). Over 50% of these antibiotic courses are inappropriate. However, interventions to improve ambulatory prescribing are little studied, and metrics to track antibiotic use are not well validated. METHODS: To validate metrics for ARTIs in adults, we conducted a retrospective cohort study from January 1, 2016 to December 31, 2016 at 32 primary care practices. We randomly selected 1,200 office visits with a coded respiratory tract diagnosis and determined by medical record review the proportion of visits in which antibiotic prescription was inappropriate using modified Infectious Diseases Society of America treatment guidelines. We determined clinic and provider characteristics associated with inappropriate prescribing. By linear regression, we also determined the aggregate metrics best correlated with inappropriate antibiotic prescribing. RESULTS: An antibiotic was prescribed in 37% of visits in which a respiratory tract diagnosis was coded. Of these prescriptions, 69% were inappropriate. Demographics associated with inappropriate prescribing included advance practice provider vs. physician (72% vs. 58%, P = 0.02), family medicine vs. internal medicine (75% vs. 63%, P = 0.01), board certification after vs. before 1997 (75% vs. 63%, P = 0.02), and practice in a non-teaching vs. teaching clinic (73% vs. 51%, P < 0.001). Rate of antibiotic prescribing in visits where any respiratory tract diagnosis was coded (R(2) = 0.23, P < 0.001) and rate of antibiotic prescribing in visits where a respiratory tract diagnosis that almost never requires an antibiotic was coded (R(2) = 0.24, P < 0.0001) were most strongly correlated with inappropriate prescribing. CONCLUSION: Rate of antibiotic prescribing in visits where any respiratory tract diagnosis was coded and rate of antibiotic prescribing in visits where a respiratory tract diagnosis that almost never requires an antibiotic was coded may be useful proxies to estimate the rate of inappropriate prescribing for ARTIs. This study could inform ambulatory antibiotic benchmarking metrics and interventions to decrease inappropriate antibiotic prescribing for ARTIs in ambulatory settings. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2018-11-26 /pmc/articles/PMC6254525/ http://dx.doi.org/10.1093/ofid/ofy210.1469 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
Hamilton, Keith W
Degnan, Kathleen O
Cluzet, Valerie
Cressman, Leigh
Adu-Gyamfi, Afia B
Tolomeo, Pam
David, Michael Z
1813. Development and Validation of Novel Ambulatory Antibiotic Stewardship Metrics
title 1813. Development and Validation of Novel Ambulatory Antibiotic Stewardship Metrics
title_full 1813. Development and Validation of Novel Ambulatory Antibiotic Stewardship Metrics
title_fullStr 1813. Development and Validation of Novel Ambulatory Antibiotic Stewardship Metrics
title_full_unstemmed 1813. Development and Validation of Novel Ambulatory Antibiotic Stewardship Metrics
title_short 1813. Development and Validation of Novel Ambulatory Antibiotic Stewardship Metrics
title_sort 1813. development and validation of novel ambulatory antibiotic stewardship metrics
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254525/
http://dx.doi.org/10.1093/ofid/ofy210.1469
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