ARI management intervention successfully reduced inappropriate antibiotic prescribing
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The implementation of a nationwide acute respiratory tract infection management intervention was associated with improved infection management and a reduction in antibiotic prescribing, a recent study showed.
“Acute respiratory tract infection (ARI) [is a] common [diagnosis] for which antibiotics are prescribed,” Karl J. Madaras-Kelly, PharmD, MPH, pharmacist at the Boise Veterans Affairs Medical Center and professor at the Idaho State University College of Pharmacy, told Healio, adding that the CDC estimates 30% of all outpatient antibiotic prescriptions are unnecessary, with ARI being the most common diagnosis for which inappropriate antibiotics are prescribed.
“In 2016, we observed in the Veterans’ Healthcare Administration (VHA) that approximately two-thirds of patients with uncomplicated ARI were treated with antibiotics, which was higher than clinically indicated,” he said. “Further, we observed that sometimes even when antibiotics were indicated, clinicians prescribed nonpreferred antibiotics (based on professional guideline recommendations). We sought to improve ARI management in outpatient settings across the VHA.”
To determine if a clinician-directed acute ARI intervention was associated with improved antibiotic prescribing and patient outcomes across a large U.S. health care system, Madaras-Kelly and colleagues performed a multicenter, retrospective, quasi-experimental analysis of outpatient visits with a diagnosis of uncomplicated ARI over a 7-year period. He explained that they initiated a voluntary campaign across all VHA medical centers designed to improve ARI management across the network. To do so, they identified clinicians that frequently treated patients with ARI and encouraged local antibiotic stewards and academic detailing personnel to engage these clinicians by providing them quarterly feedback reports on their antibiotic prescribing patterns compared with their peers, coupled with periodic education on the appropriate management of ARIs through academic detailing. The researchers then tracked improvements in antibiotic use and clinical outcomes associated with ARI visits across the VHA.
In total, the researchers reviewed 1,003,509 uncomplicated ARI visits before and 323,023 after the implementation of the intervention. They found that the probability to receive antibiotics for ARI decreased after intervention implementation (OR = 0.82; 95% CI, 0.78-0.86) and that facilities with the highest quartile of intervention intensity had larger reductions in antibiotic prescribing (OR = 0.69; 95% CI, 0.59-0.8) compared with nonparticipating facilities (OR = 0.89; 95% CI, 0.73-1.09). According to the study, return visits (OR = 1; 95% CI, 0.94-1.07) and infection-related hospitalizations (OR = 1.21; 95% CI, 0.92-1.59) were not different before and after implementation within facilities that performed intensive intervention implementation.
“Systematically providing feedback to clinicians on their antibiotic prescribing patterns compared to their peers, coupled with targeted education on ARIs, improved ARI management across a very large health care system,” Madaras-Kelly concluded.
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