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'Simple' stewardship intervention reduces antimicrobial prescriptions
A multifaceted outpatient antimicrobial stewardship intervention implemented at seven primary care clinics significantly reduced overall antibiotic prescriptions, as well as unnecessary and suboptimal prescriptions rates, researchers reported. The reductions were sustained even after one intervention — peer comparison — was removed.
“Antimicrobial stewardship interventions routed in behavioral science have been shown to be effective in decreasing inappropriate antibiotic prescribing in prior studies focusing on specific disease states such as upper respiratory tract infections,” Deanna Buehrle, PharmD, an infectious diseases clinical pharmacist in the VA Pittsburgh Healthcare System, told Healio.
Buehrle and colleagues conducted a prospective, observational study in seven primary care clinics. The stewardship intervention consisted of provider education, peer comparison — which was discontinued after 6 months — and computer decision support tools.
They compared prescribing practices at baseline, which was January to June 2016; during the intervention period, between January and June 2017; and after the intervention, from January to June 2018.
At baseline, the mean number of antibiotic prescriptions was 76.9 per 1,000 visits, which decreased 35.6% to 49.5 during the intervention period, and fell 26.8% to 56.3 after the intervention, according to Buehrle and colleagues.
The rate of unnecessary antibiotic prescribing was 58.8% at baseline. This decreased to 37.8% during the intervention period and to 44.3% post-intervention. Specifically, there was a 35.7% reduction between the baseline and intervention periods and a 24.7% reduction between baseline and post-intervention.
At baseline, 19.9% of all antibiotics were prescribed optimally, which increased to 36.6% during the intervention and 34.9% after the intervention.
“We achieved sustained improvements in prescribing with a simple and non-labor-intensive intervention,” Buehrle said. “We believe that our program should be reproducible at most facilities that are able to track their antibiotic prescribing rate.”
Buehrle said targeted providers — primary care providers or other provider types — can be educated by a health care professional trained in infectious diseases, such as an infectious diseases physician, advanced practice provider, or pharmacist, and computer decision support tools can be added or updated.
“We conducted educational sessions lasting approximately 30 minutes,” Buehrle said. “Next, periodic (ie, monthly) peer comparison emails can be sent to the targeted providers. To compile the peer comparison emails, programs would need to go through their monthly antibiotic prescribing data and create graphs depicting prescriber’s rates compared to their peers.” – by Marley Ghizzone
Disclosures: Buehrle reports no relevant financial disclosures. Please see the study for all other authors relevant financial disclosures.