Urgent care stewardship program improves antibiotic prescribing
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Antibiotic prescribing in dozens of urgent care sites decreased after the introduction of a stewardship program, according to data presented at IDWeek.
“Use of urgent care is growing rapidly, and antibiotic overuse in urgent care is greater than any other outpatient setting,” Adam L. Hersh, MD, PhD, pediatric infectious diseases physician at the University of Utah, told Healio.
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Hersh and colleagues designed an urgent care stewardship program for Intermountain Healthcare's 39 urgent care sites based on the CDC Core Elements of Antibiotic Prescribing. According to Hersh, urgent care antibiotic prescribing accounts for over 50% of outpatient antibiotic use in the Intermountain system.
The program included media campaigns, electronic health record tools and a prescribing dashboard for clinicians to use, as well as efforts to educate patients and providers about appropriate diagnosis and prescribing for respiratory conditions. The study’s preintervention period was from August 2017 through June 2019, while the intervention period was from July 2019 through June 2020.
The researchers compared the preintervention and intervention periods to determine the percentage of respiratory visits in which an antibiotic was prescribed, the percentage of encounters in which patients received antibiotics for conditions where no antibiotics are indicated and the percentage of encounters in which patients received first-line recommended therapy for conditions in which antibiotics may be necessary.
According to the study, there were 1,559,403 urgent care encounters during the study period, with 41.5% being for respiratory conditions. An interim analysis showed that after 7 months of the intervention, the percentage of patients with respiratory conditions who received an antibiotic prescription declined from 49.9% preintervention to 35.3% during the intervention (OR = 0.73; 95% CI, 0.71, 0.76).
Antibiotic prescribing reached a low of 30% during February 2020, according to the study. Additionally, the study showed that prescribing for conditions where antibiotics are not indicated (such as bronchitis) decreased (OR = 0.31; 95% CI, 0.26-0.36), whereas first-line recommended therapy increased (OR = 1.28; 95% CI, 1.20-1.26) during the intervention.
“Even with significant reductions in antibiotic use, there were no detectable harms for patients in terms of adverse clinical outcomes or patient satisfaction,” Hersh said.
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Hersh AL, et al. Oral Abstract 16. Presented at: IDWeek; Oct. 21-25, 2020 (virtual meeting).
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