Intervention reduced inappropriate antibiotic use at urgent cares
Key takeaways:
- An antibiotic stewardship intervention decreased inappropriate prescribing for patients with bronchitis and viral upper respiratory infections.
- Active clinician engagement is necessary to maximize the impact.
An antibiotic stewardship intervention at urgent care centers was associated with lower rates of inappropriate prescribing for bronchitis and viral upper respiratory infections, although active clinician engagement is necessary, researchers found.
“Prior studies have shown high rates of inappropriate antibiotic prescribing in urgent care settings, which is concerning given their rapid growth as an outpatient care option,” Daniel E. Park MSPH, PhD, senior research scientist at George Washington University, told Healio.
“A number of factors could contribute to inappropriate prescribing in these settings, including time constraints, limited provider-patient rapport, and diagnostic uncertainty. Our goal was to assess a broadly generalizable set of antibiotic stewardship interventions across a geographically diverse network of urgent care centers to determine their effectiveness in reducing inappropriate antibiotic prescribing,” he said.
To do so, Park and colleagues conducted a quality improvement study comparing inappropriate antibiotic prescribing rates in 49 urgent care centers before and after the stewardship intervention was introduced.
According to the study, the intervention included signing a commitment statement and selecting from five different intervention options during three plan-do-study-act cycles.
During the first cycle, clinicians signed a commitment statement and chose interventions — including the use of patient education handouts, patient engagement materials such as videos, articles and letter templates, clinician education, treatment guidelines and signs and social media materials — to implement from the available package of validated materials.
During the second and third cycles, clinicians reviewed progress and selected new interventions to implement — if they wanted.
The primary outcome was the percentage of urgent care encounters with inappropriate prescribing for viral upper respiratory tract infections (URTIs) or bronchitis.
In total,15,385 encounters were assessed during the study. The overall rate of inappropriate prescribing decreased by 39% (adjusted OR = 0.61; 95% CI, 0.48-0.77) during the intervention period among clinicians considered “actively engaged” — those participating in data collection, implementing stewardship efforts, attending a minimum of four webinars and providing regular monthly feedback for the entire study period — compared with the baseline period.
For specific respiratory diagnoses — for which the authors noted urgent care centers have high rates of antibiotic prescribing — the intervention was associated with a 48% decrease in inappropriate antibiotic prescribing for bronchitis (aOR = 0.52; 95% CI, 0.33-0.83) and 33% decrease in inappropriate antibiotic prescribing for viral URTIs (aOR = 0.67; 95% CI, 0.55-0.82) among actively engaged clinicians compared with the baseline period.
Data showed, however, that the intervention did not result in significant changes for clinicians not actively engaged. Among these clinicians, there was a 34% decrease in inappropriate prescribing for bronchitis (aOR = 0.66; 95% CI, 0.42-1.01) and no decrease compared with the baseline period in inappropriate prescribing for viral URTIs.
“Antibiotic resistance is a critical and growing public health threat, contributing to millions of deaths globally each year,” Park said. “Our findings suggest that we have effective interventions that can significantly reduce inappropriate antibiotic prescribing across diverse urgent care settings.”
“However, their success largely depends on individual provider engagement, emphasizing the need for active participation and commitment at the individual level to drive meaningful change,” he said.
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