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1334. A Qualitative Assessment of Drivers of Antimicrobial Prescribing for Pediatric Patients in Diverse Ambulatory Settings

BACKGROUND: Antimicrobial prescribing rates vary across ambulatory settings and provider types. We sought to identify and compare non-clinical drivers of antimicrobial prescribing for children across diverse outpatient settings. METHODS: We recruited physicians and advanced practice providers (APPs)...

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Autores principales: Spencer, Hillary, Katz, Sophie E, Audet, Carolyn, Banerjee, Ritu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7776848/
http://dx.doi.org/10.1093/ofid/ofaa439.1516
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author Spencer, Hillary
Katz, Sophie E
Audet, Carolyn
Banerjee, Ritu
Banerjee, Ritu
author_facet Spencer, Hillary
Katz, Sophie E
Audet, Carolyn
Banerjee, Ritu
Banerjee, Ritu
author_sort Spencer, Hillary
collection PubMed
description BACKGROUND: Antimicrobial prescribing rates vary across ambulatory settings and provider types. We sought to identify and compare non-clinical drivers of antimicrobial prescribing for children across diverse outpatient settings. METHODS: We recruited physicians and advanced practice providers (APPs) working in primary care, urgent care (walk-in and pediatric after-hours clinics), and retail health clinics affiliated with Vanderbilt University Medical Center (Table 1). We conducted in-person or telephone interviews using an interview guide created through an iterative process of literature review and sequential pilot testing with residents and administrators from included settings. All interviews were recorded and transcribed verbatim. Analysis is ongoing using inductive methods. The study was IRB approved with a waiver of consent. RESULTS: Among the 38 providers interviewed to date, 22 (58%) were APPs. Twenty-eight (74%) interviews were conducted by telephone. In a closed-ended question, most providers (82%) identified “guideline recommended” as the primary factor informing their prescribing decisions. Providers perceived that guideline concordant care was determined by a complex interaction of patient, provider, and setting factors (Figure). A major theme identified by providers was that standardized antibiotic prescribing practices within each clinic setting and the larger community was perceived to inform parental expectations. Additionally, shaping parental expectations in a way that aligns with guidelines is a process that happens over time rather than being a one-time event. (Figure, Table 2) CONCLUSION: In all outpatient settings, providers caring for children cited clinical guidelines as the most important factor influencing antibiotic prescribing. Providers felt that adherence to guidelines had downstream benefits including standardization of prescribing practices which may shape parental expectations in a way that aligns with guidelines, thus facilitating guideline-concordant care in future encounters. These findings can inform design of outpatient stewardship interventions. Additional provider recruitment and analysis by provider and setting type is ongoing. DISCLOSURES: Hillary Spencer, MD, MPH, NIH (T32 grant support) (Grant/Research Support)
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spelling pubmed-77768482021-01-07 1334. A Qualitative Assessment of Drivers of Antimicrobial Prescribing for Pediatric Patients in Diverse Ambulatory Settings Spencer, Hillary Katz, Sophie E Audet, Carolyn Banerjee, Ritu Banerjee, Ritu Open Forum Infect Dis Poster Abstracts BACKGROUND: Antimicrobial prescribing rates vary across ambulatory settings and provider types. We sought to identify and compare non-clinical drivers of antimicrobial prescribing for children across diverse outpatient settings. METHODS: We recruited physicians and advanced practice providers (APPs) working in primary care, urgent care (walk-in and pediatric after-hours clinics), and retail health clinics affiliated with Vanderbilt University Medical Center (Table 1). We conducted in-person or telephone interviews using an interview guide created through an iterative process of literature review and sequential pilot testing with residents and administrators from included settings. All interviews were recorded and transcribed verbatim. Analysis is ongoing using inductive methods. The study was IRB approved with a waiver of consent. RESULTS: Among the 38 providers interviewed to date, 22 (58%) were APPs. Twenty-eight (74%) interviews were conducted by telephone. In a closed-ended question, most providers (82%) identified “guideline recommended” as the primary factor informing their prescribing decisions. Providers perceived that guideline concordant care was determined by a complex interaction of patient, provider, and setting factors (Figure). A major theme identified by providers was that standardized antibiotic prescribing practices within each clinic setting and the larger community was perceived to inform parental expectations. Additionally, shaping parental expectations in a way that aligns with guidelines is a process that happens over time rather than being a one-time event. (Figure, Table 2) CONCLUSION: In all outpatient settings, providers caring for children cited clinical guidelines as the most important factor influencing antibiotic prescribing. Providers felt that adherence to guidelines had downstream benefits including standardization of prescribing practices which may shape parental expectations in a way that aligns with guidelines, thus facilitating guideline-concordant care in future encounters. These findings can inform design of outpatient stewardship interventions. Additional provider recruitment and analysis by provider and setting type is ongoing. DISCLOSURES: Hillary Spencer, MD, MPH, NIH (T32 grant support) (Grant/Research Support) Oxford University Press 2020-12-31 /pmc/articles/PMC7776848/ http://dx.doi.org/10.1093/ofid/ofaa439.1516 Text en © The Author 2020. 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 Poster Abstracts
Spencer, Hillary
Katz, Sophie E
Audet, Carolyn
Banerjee, Ritu
Banerjee, Ritu
1334. A Qualitative Assessment of Drivers of Antimicrobial Prescribing for Pediatric Patients in Diverse Ambulatory Settings
title 1334. A Qualitative Assessment of Drivers of Antimicrobial Prescribing for Pediatric Patients in Diverse Ambulatory Settings
title_full 1334. A Qualitative Assessment of Drivers of Antimicrobial Prescribing for Pediatric Patients in Diverse Ambulatory Settings
title_fullStr 1334. A Qualitative Assessment of Drivers of Antimicrobial Prescribing for Pediatric Patients in Diverse Ambulatory Settings
title_full_unstemmed 1334. A Qualitative Assessment of Drivers of Antimicrobial Prescribing for Pediatric Patients in Diverse Ambulatory Settings
title_short 1334. A Qualitative Assessment of Drivers of Antimicrobial Prescribing for Pediatric Patients in Diverse Ambulatory Settings
title_sort 1334. a qualitative assessment of drivers of antimicrobial prescribing for pediatric patients in diverse ambulatory settings
topic Poster Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7776848/
http://dx.doi.org/10.1093/ofid/ofaa439.1516
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