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Physician preferences on antibiotic prescribing feedback may improve ASPs
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Research has shown that feedback on antimicrobial prescribing practices can reduce prescription rates, according to researchers. In a recent survey, most inpatient providers said they would prefer to receive feedback on a quarterly basis through email.
This information, among other findings from the survey, could be used to improve providers’ acceptance of antimicrobial use (AU) feedback, which would ultimately improve the implementation of antimicrobial stewardship programs (ASPs), according to Tara H. Lines, PharmD, infectious disease pharmacy resident at Vanderbilt University Medical Center, and colleagues.
“Antimicrobial use feedback is an important component of antibiotic stewardship initiatives that can improve the use of these drugs,” Lines said in a news release. “Understanding and anticipating the best way to communicate with providers can help drive change by ensuring providers are reached effectively.”
Lines and colleagues emailed a 20-question survey to 766 adult inpatient providers in critical care, emergency medicine, surgery, infectious diseases and other medical subspecialties at Vanderbilt University Hospital. The survey included hypothetical scenarios addressing AU attribution, as well as questions on preferred feedback strategies and barriers to feedback.
Of the 211 providers who responded to the survey, 89% said they would prefer their institution rather than external personnel designate which team of health care providers are responsible for AU (ie, ED staff vs. admission staff).
During specific hypothetical scenarios:
- 83% of providers attributed AU to the ED team at the time of admission;
- 91% of providers attributed AU to the ICU team at the time of ICU transfer and therapy change; and
- when a new ICU team takes over, 74% of providers attributed AU to the new team even though they were not part of the process of changing therapy the preceding day.
Despite the overall agreement in managing early care, AU attribution varied among the providers when scenarios became more complex (P = .012), with different specialties accepting responsibility for AU or deferring attribution to consult services, such as ID, which the researchers said, “may pose issues in creating a culture of shared responsibility for antimicrobial stewardship.”
Regarding feedback preferences, 69% of physicians said they wanted to receive AU feedback on a quarterly basis and 73% said they wanted to receive feedback through email. Most providers also said they wanted AU reporting to be based on service rather than patient care unit (63% vs. 27%), and to be compared with other providers within their service (64%).
All provider services were equally concerned that AU attribution would not account for appropriateness of AU or reporting accuracy. Regardless, 51% of providers anticipated that AU feedback would change their practice.
“Data can help drive change; however, in order to implement meaningful change, we must overcome barriers and use these data to improve the use of antibiotics,” Lines said. “As current national reporting utilizes unit-based and facilitywide data, local [ASPs] will play a crucial role in examining provider- or service-level data to identify and act on stewardship opportunities and to increase the acceptability of these programs.”
Line and colleagues concluded that survey responses from other health care staff, including physician assistants, nurse practitioners, pharmacists and nurses, will be needed to develop an optimal AU feedback program. – by Stephanie Viguers
Disclosures: The authors report no relevant financial disclosures.
Perspective
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I think the findings from this study are very important to improving the impact of ASPs. Audit and feedback are the most effective means of behavioral change for antibiotic stewardship practice, and physicians and health care organizations are in an age of unprecedented availability of data that can provide us valuable feedback — on our practice patterns and also our patients’ outcomes — to improve our practice and the care of our patients. However, how to best validate, synthesize, present and use that data to improve care remains a big question. This study found that physicians had different preferences and concerns about the antibiotic use data used for feedback. Physicians specifically called into question approaches that attribute antibiotic use patterns to individual providers for complex patients, in whom multiple consulting teams might participate in therapeutic decisions. Additional work that further explores physicians’ attitudes and responses to feedback is critical to creating effective audit-and-feedback approaches that leverage our data to improve care in the future.
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