Stewardship program reduces ambulatory antibiotic prescriptions
Click Here to Manage Email Alerts
A national antibiotic stewardship program was associated with declines in antibiotic prescribing among nearly 300 ambulatory care settings, mostly primary and urgent care practices, according to data presented at IDWeek.
The project is part of an effort by HHS’s Agency for Healthcare Research and Quality (AHRQ) to combat antibiotic resistance in the United States.
It “focuses on the ambulatory cohort of a 5-year implementation project that aimed to improve antibiotic stewardship in three distinct settings of care: acute care, long-term care, and ambulatory care, by building antibiotic stewardship from the bottom up and reframing stewardship as an important approach for patient safety,” Sara C. Keller, MD, MPH, MSPH, an assistant professor of medicine at Johns Hopkins University School of Medicine, and Melissa A. Miller, MD, MS, FCCM, a medical officer at the AHRQ, explained to Healio in a joint response.
“Most antibiotics prescribed are prescribed in ambulatory settings, where antibiotic stewardship is an unmet need, and we don’t know as much about how to implement stewardship in ambulatory care,” they said. “These results provide a glimpse of how antibiotic stewardship can be done in ambulatory care.”
The researchers used webinars, audio presentations, educational tools and office hours to engage clinicians and staff leaders about judicious antibiotic prescribing and incorporate best practices for the management of common infections.
For the study, they collected data on total visits, visits for acute respiratory infection, and antibiotic prescribing and compared the results from the pre-intervention period (September to November 2019) and the intervention period (December 2019 to November 2020).
Overall, 467 practices enrolled and 389 (83%) completed the program, including 162 primary care practices, 160 urgent care practices and 49 federally supported practices, the researchers reported. Among these, 292 practices submitted complete data totaling 6,590,485 visits.
The data showed that overall visits per practice month declined between March and May 2020 but gradually returned to baseline by the end of the program end, whereas ARI visits per practice month declined significantly between March and May 2020 — followed by an increase — but overall remained below baseline by the program’s end.
They found that total antibiotic prescribing declined by around nine prescriptions per 100 visits (95% CI, –10 to –8) — from 18.2 in September 2019 to 9.5 in November 2020. ARI-related antibiotic prescriptions decreased by around 15 per 100 ARI visits by the program’s end (95% CI, –17 to –12), from 39.2 to 24.7, with penicillin class prescriptions seeing the biggest reduction.
“We know that it’s possible to improve antibiotic prescribing, but less is understood about how to do that, especially in the ambulatory setting,” Keller and Miller said. “These results demonstrate that, with some tools and resources and engagement of practices, members of ambulatory practices can work together to improve antibiotic prescribing.”
They said the program could serve as a model for ambulatory practices and that they plan to release a toolkit to facilitate nationwide implementation in the next year.
Collapse
Keller SC, et al. Abstract 161. Presented at: IDWeek; Sept. 29-Oct. 3, 2021 (virtual meeting).
Read more about
Click Here to Manage Email Alerts