Antibiotic order panel guides management of CAP in outpatient setting

Key takeaways:

• Over 61% of community-acquired pneumonia outpatient encounters in which the panel was used were guideline adherent.
• Clinical decision support tools can increase quality of care, an expert said.

Use of a prepopulated antibiotic order panel resulted in greater adherence to guideline recommendations among physicians who treated outpatients with community-acquired pneumonia, according to a study presented at IDWeek.

Ryan W. Stevens, PharmD, BCIDP, an assistant professor of medicine at Mayo Clinic, said his research team’s goal was to increase guideline adherence for community-acquired pneumonia (CAP) management “in terms of both drug selection and duration of therapy.”

“We thought this best accomplished through use of clinical decision support tools, which could be integrated into clinician workflows to simplify the antimicrobial ordering process,” he told Healio.

The study evaluated outpatient encounters — 134 with the panel and 218 without it — that occurred at Mayo Clinic in 2021 and 2022.

Overall, guideline-adherent prescribing occurred in 61.9% of panel encounters and 29.4% of nonpanel encounters.

The researchers found that the most common reason for guideline nonadherence during encounters when the panel was used was inappropriate drug selection (88.2%), mostly because the incorrect treatment panel had been selected based on patient comorbidity status (66.7%).

Stevens and colleagues also noted that individual antibiotic utilization rates varied between panel and nonpanel cohorts. For example, outpatient encounters in which the panel was used resulted in higher rates of amoxicillin and amoxicillin/clavulanate use and lower rates of azithromycin and doxycycline use, and therapy durations lasting longer than 5 days were more common in the nonpanel cohort (34.4% vs. 7.5%; P < .01).

Stevens explained that the rate of adherence was “surprisingly low” in the sample of patients who were managed without the panel.

“I find that this may be due to the fact that the presence or absence of certain patient comorbidities impacts appropriate drug selection in this syndrome, particularly those with baseline comorbidities being candidates for broader spectrum oral therapy with agents targeting both typical and atypical pathogens,” he said.

Stevens said he was also surprised that 38% of panel encounters were not guideline adherent.

“This highlights the need for further optimization of clarity in the panel categories, as well as an opportunity to work toward automatically defaulting the panel to specific sections based on other features of the medical record,” he said.

According to Stevens, the findings suggest that clinical decision support tools integrated into a standard workflow can “dramatically” improve quality of care.

“This is important given that encounters in the ambulatory care space are often high volume and short duration in nature,” he said. “We all have the desire to provide high-quality care to patients, but this also needs to be executed in a time-efficient manner given the intrinsic qualities of the care environment.”

These tools would allow clinicians “to spend more time with their patients and less time navigating order entry and resources outside the medical record, while also improving the accuracy of therapeutic decisions and medication orders,” he said.