scholarly journals Comparison of diagnosis and prescribing practices between virtual visits and office visits for adults diagnosed with uncomplicated urinary tract infections within a primary care network

2020 ◽  
pp. 1-6
Author(s):  
Kaitlyn L. Johnson ◽  
Lisa E. Dumkow ◽  
Lisa A. Salvati ◽  
Kristen M. Johnson ◽  
Megan A. Yee ◽  
...  
Keyword(s):  
Primary Care ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Antibiotic Prescribing ◽  
Office Visits ◽  
Prescribing Practices ◽  
Care Network ◽  
Antimicrobial Prescribing ◽  
Virtual Visits ◽  
Tract Infections

Abstract Objectives: Telemedicine visits are an increasingly popular method of care for mild infectious complaints, including uncomplicated urinary tract infections (UTIs), and they are an important target for antimicrobial stewardship programs (ASPs) to evaluate quality of prescribing. In this study, we compared antimicrobial prescribing in a primary care network for uncomplicated UTIs treated through virtual visits and at in-office visits. Design: Retrospective cohort study comparing guideline-concordant antibiotic prescribing for uncomplicated UTI between virtual visits and office visits. Setting: Primary care network composed of 44 outpatient sites and a single virtual visit platform. Patients: Adult female patients diagnosed with a UTI between January 1 and December 31, 2018. Methods: Virtual visit prescribing was compared to office visit prescribing, including agent, duration, and patient outcomes. The health system ASP provides annual education to all outpatient providers regarding local antibiogram trends and prescribing guidelines. Guideline-concordant therapy was assessed based on the network’s ASP guidelines. Results: In total, 350 patients were included, with 175 per group. Patients treated for a UTI through a virtual visit were more likely to receive a first-line antibiotic agent (74.9% vs 59.4%; P = .002) and guideline-concordant duration (100% vs 53.1%; P < .001). Patients treated through virtual visits were also less likely to have a urinalysis (0% vs 97.1%; P < .001) or urine culture (0% vs 73.1%; P < .001) ordered and were less likely to revisit within 7 days (5.1% vs 18.9%; P < .001). Conclusions: UTI care through a virtual visit was associated with more appropriate antimicrobial prescribing compared to office visits and decreased utilization of diagnostic and follow-up resources.

scholarly journals 125. Comparison of Diagnosis and Prescribing Practices between Virtual Visits and Office Visits for Adults Diagnosed with Uncomplicated Urinary Tract Infections within a Primary Care Network

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S75-S76
Author(s):  
Kaitlyn Johnson ◽  
Lisa E Dumkow ◽  
Lisa Salvati ◽  
Kristen Johnson ◽  
Megan Yee ◽  
...  
Keyword(s):  
Primary Care ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Adult Female ◽  
Antibiotic Prescribing ◽  
Office Visits ◽  
Care Network ◽  
Female Patients ◽  
Virtual Visits ◽  
Tract Infections

Abstract Background Urinary tract infections (UTIs) are one of the most common infectious indications for antibiotic prescribing in the outpatient setting. With the exponential growth of virtual visits over the past decade, virtual visits represent an important ambulatory care target for antimicrobial stewardship programs outside of traditional office visits. This study aimed to compare the appropriateness of antimicrobial therapy between virtual visits and office visits for adult females diagnosed with uncomplicated UTIs within a primary care network. Methods This retrospective cohort study evaluated adult female patients diagnosed with a UTI within a primary care network comprised of 44 outpatient sites. The primary objective was to compare guideline-concordant antibiotic prescribing between virtual visits and office visits. Guideline-concordance was determined based on local antibiogram-based treatment recommendations. Secondary objectives included comparing appropriate treatment duration and use of diagnostic testing resources between groups. Additionally, patient outcomes were compared between groups including 48-hour, 7-day, and 30-day re-visits, or development of Clostridioides difficile infection within 30 days. Results A total of 350 patients were included in this study, with 175 patients in each group. Patients treated for a UTI via a virtual visit were more likely to be prescribed a first-line antibiotic (74.9% vs 59.4%; P = 0.002). Additionally, virtual visits were more likely to prescribe an appropriate duration (100% vs 53.1%; P= &lt; 0.0001). Patients treated via office visits were more likely to have a urinalysis (0% vs 97.1%; P &lt; 0.001) and urine culture (0% vs 73.1%; P &lt; 0.0001) ordered. There was no difference between groups in 48-hour or 30-day revisits, however, patients completing office visits were more likely to have a revisit within 7 days (18.9% vs 5.1%; P &lt; 0.0001). In multivariate logistic regression, UTI care via office visit was the only independent risk factor for 7-day revisit (OR 3.74, 95% CI 1.31 -10.67). Conclusion In adult female patients presenting with uncomplicated UTIs, care at a virtual visit was associated with significantly improved antimicrobial prescribing compared to office visits and decreased utilization of diagnostic and follow-up resources. Disclosures All Authors: No reported disclosures

scholarly journals Comparison of Diagnosis and Prescribing Practices Between Virtual Visits and Office Visits for Adults Diagnosed With Sinusitis Within a Primary Care Network

2019 ◽  
Vol 6 (9) ◽  
Author(s):  
Kristen M Johnson ◽  
Lisa E Dumkow ◽  
Kayla W Burns ◽  
Megan A Yee ◽  
Nnaemeka E Egwuatu
Keyword(s):  
Primary Care ◽  
Antimicrobial Stewardship ◽  
Outpatient Setting ◽  
Adult Patients ◽  
Antibiotic Prescribing ◽  
Office Visits ◽  
Care Network ◽  
Virtual Visits ◽  
Tract Infections ◽  
To Receive

Abstract Background Many antibiotics prescribed in the outpatient setting result from upper respiratory tract infections (URTIs); however, these infections are often viral. Virtual visits have emerged as a popular alternative to office visits for URTIs and may be an important target for antimicrobial stewardship programs. Methods This retrospective cohort study evaluated adult patients diagnosed with sinusitis treated within a single primary care network. The primary objective was to compare guideline-concordant diagnosis between patients treated via virtual visits vs in-office visits. Guideline-concordant bacterial sinusitis diagnosis was based on national guideline recommendations. Secondary objectives included comparing guideline-concordant antibiotic prescribing between groups and 24-hour, 7-day, and 30-day revisits. Results A total of 350 patients were included in the study, with 175 in each group. Patients treated for sinusitis were more likely to receive a guideline-concordant diagnosis in the virtual visit group (69.1% vs 45.7%; P &lt; .001). Additionally, patients who completed virtual visits were less likely to receive antibiotics (68.6% vs 94.3%; P &lt; .001). Guideline-concordant antibiotic selection was similar between groups (67.5% vs 64.8%; P = .641). The median duration of therapy in both groups was 10 days (P = .88). Patients completing virtual visits were more likely to revisit for sinusitis within 24 hours (8% vs 1.7%; P = .006) and within 30 days (14.9% vs 7.4%; P = .027). Conclusions In adult patients presenting with sinusitis, care at a virtual visit was associated with an increase in guideline-concordant diagnosis and a decrease in antibiotic prescribing compared with in-office primary care visits. Virtual visit platforms may be a valuable tool for antimicrobial stewardship programs in the outpatient setting.

scholarly journals An Assessment of Inappropriate Antibiotic Use and Guideline Adherence for Uncomplicated Urinary Tract Infections

2018 ◽  
Vol 5 (9) ◽  
Author(s):  
Michael J Durkin ◽  
Matthew Keller ◽  
Anne M Butler ◽  
Jennie H Kwon ◽  
Erik R Dubberke ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Antibiotic Use ◽  
Emergency Department Visits ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Duration Of Treatment ◽  
Minimal Impact ◽  
Tract Infections ◽  
The Impact

Abstract Background In 2011, The Infectious Diseases Society of America released a clinical practice guideline (CPG) that recommended short-course antibiotic therapy and avoidance of fluoroquinolones for uncomplicated urinary tract infections (UTIs). Recommendations from this CPG were rapidly disseminated to clinicians via review articles, UpToDate, and the Centers for Disease Control and Prevention website; however, it is unclear if this CPG had an impact on national antibiotic prescribing practices. Methods We performed a retrospective cohort study of outpatient and emergency department visits within a commercial insurance database between January 1, 2009, and December 31, 2013. We included nonpregnant women aged 18–44 years who had an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for a UTI with a concurrent antibiotic prescription. We performed interrupted time series analyses to determine the impact of the CPG on the appropriateness of the antibiotic agent and duration. Results We identified 654 432 women diagnosed with UTI. The patient population was young (mean age, 31 years) and had few comorbidities. Fluoroquinolones, nonfirstline agents, were the most commonly prescribed antibiotic class both before and after release of the guidelines (45% vs 42%). Wide variation was observed in the duration of treatment, with &gt;75% of prescriptions written for nonrecommended treatment durations. The CPG had minimal impact on antibiotic prescribing behavior by providers. Conclusions Inappropriate antibiotic prescribing is common for the treatment of UTIs. The CPG was not associated with a clinically meaningful change in national antibiotic prescribing practices for UTIs. Further interventions are necessary to improve outpatient antibiotic prescribing for UTIs.

scholarly journals 2076. Comparison of Diagnosis and Prescribing Practices between Virtual Visits and Office Visits for Sinusitis within a Primary Care Network

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S700-S700
Author(s):  
Kristen Johnson ◽  
Kayla Burns ◽  
Lisa Dumkow ◽  
Megan Yee ◽  
Nnaemeka Egwuatu
Keyword(s):  
Primary Objective ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
Office Visits ◽  
Prescribing Practices ◽  
National Guidelines ◽  
Duration Of Treatment ◽  
Online Questionnaire ◽  
Virtual Visits ◽  
Tract Infections

Abstract Background The majority of antibiotics prescribed in the outpatient setting result from upper respiratory tract infections; however, these infections are often viral. Virtual visits (VV) have emerged as a popular alternative to office visits (OV) for sinusitis complaints and are an important area for stewardship programs to target for intervention. Methods A retrospective cohort study was conducted utilizing the outpatient electronic medical record for Mercy Health Physician Partners (MHPP) and Zipnosis database for VV to compare diagnosis and prescribing between OV and VV for sinusitis. VV consisted of an online questionnaire for patients to complete, which was then sent to a provider to evaluate electronically without face-to-face interaction. Adult patients were included with a diagnosis code for sinusitis during the 6-month study period from January to June 2018. The primary objective was to compare rates of appropriate diagnosis of viral vs. bacterial sinusitis between OV and VV, based on national guideline recommendations. Secondary objectives were to compare the appropriateness of antibiotic prescribing and supportive therapy prescribing between OV and VV, as well as 24-hour, 7-day and 30-day re-visits. Results A total of 350 patients were included in the study (OV n = 175, VV n = 175). Appropriate diagnosis per national guidelines was 45.7% in OV compared with 69.1% in the VV group (P < 0.001). Additionally, patients that completed VV were less likely to receive antibiotic prescriptions (OV 94.3%, VV 68.6%, P < 0.001). Guideline-concordant antibiotic prescribing was similar between groups (OV 60.6%, VV 58.3%, P = 0.70) and both visit types had a median duration of treatment of 10 days (P = 0.88). Patients that completed VV were more likely to re-visit for sinusitis within 24 hours (OV 1.7%, VV 8%, P = 0.006) and within 30-days (OV 7.4%, VV 14.9%, P = 0.027). In multivariate logistic regression the only factor independently associated with 24-hour re-visit was patient self-request for antibiotics (OR 0.20, 95% CI 0.06–0.68). Conclusion Appropriate diagnosis of sinusitis was more likely in the VV group, which shows that VV provides a good platform to target outpatient antimicrobial prescribing. These findings support opportunities for antimicrobial stewardship intervention in both OV and VV. Disclosures All authors: No reported disclosures.

scholarly journals 1475. Understanding Prescribing Practices for Uncomplicated Urinary Tract Infections (UTIs) in the Primary Care Setting: A Pilot Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S538-S538
Author(s):  
Mark Pinkerton ◽  
Jahnavi Bongu ◽  
Aimee James ◽  
Michael Durkin
Keyword(s):  
Primary Care ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Clinical Decision ◽  
Primary Care Providers ◽  
Care Providers ◽  
Prescribing Practices ◽  
Support Tools ◽  
Tract Infections ◽  
Clinical Decision Support Tools

Abstract Background Uncomplicated urinary tract infections (UTIs) should be treated empirically with a short course of narrow-spectrum antibiotics. However, many clinicians order unnecessary tests and treat with long courses of antibiotics. The objective of this study was to understand how internists clinically approach UTIs. Methods We conducted semi-structured qualitative interviews of community primary care providers (n = 15) and internal medicine residents (n = 15) in St. Louis, Missouri from 2018 to 2019 to explore why clinical practices deviate from evidence-based guidelines. Interviews were transcribed, de-identified, and coded by two independent researchers using NVivo qualitative software. A Likert scale was used to evaluate preferences for possible interventions. Results Several common themes emerged. Both providers and residents ordered urine tests to “confirm” presence of urinary tract infections. Antibiotic prescriptions were often based on historical practice and anecdotal experience. Providers were more comfortable treating over the phone than residents and tended to prescribe longer courses of antibiotics. Both providers and residents voiced frustrations with guidelines being difficult to easily incorporate due to length and extraneous information. Preferences for receiving and incorporating guidelines into practice varied. Both groups felt benchmarking would improve prescribing practices, but had reservations about implementation. Pragmatic clinical decision support tools were favored by providers, with residents preferring order sets and attendings preferring nurse triage algorithms. Conclusion Misconceptions regarding urinary tract infection management were common among residents and community primary care providers. Multifaceted interventions that include provider education, synthesis of guidelines, and pragmatic clinical decision support tools are needed to improve antibiotic prescribing and diagnostic testing; optimal interventions to improve UTI management may vary based on provider training level. Disclosures All authors: No reported disclosures.

scholarly journals Qualitative Analysis of Primary Care Provider Prescribing Decisions for Urinary Tract Infections

Antibiotics ◽  
2019 ◽  
Vol 8 (2) ◽  
pp. 84 ◽  
Author(s):  
Larissa Grigoryan ◽  
Susan Nash ◽  
Roger Zoorob ◽  
George J. Germanos ◽  
Matthew S. Horsfield ◽  
...  
Keyword(s):  
Primary Care ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Primary Care Providers ◽  
Effective Control ◽  
Antibiotic Prescribing ◽  
Care Providers ◽  
Sources Of Information ◽  
Acute Cystitis ◽  
Tract Infections

Inappropriate choices and durations of therapy for urinary tract infections (UTI) are a common and widespread problem. In this qualitative study, we sought to understand why primary care providers (PCPs) choose certain antibiotics or durations of treatment and the sources of information they rely upon to guide antibiotic-prescribing decisions. We conducted semi-structured interviews with 18 PCPs in two family medicine clinics focused on antibiotic-prescribing decisions for UTIs. Our interview guide focused on awareness and familiarity with guidelines (knowledge), acceptance and outcome expectancy (attitudes), and external barriers. We followed a six-phase approach to thematic analysis, finding that many PCPs believe that fluoroquinolones achieve more a rapid and effective control of UTI symptoms than trimethoprim-sulfamethoxazole or nitrofurantoin. Most providers were unfamiliar with fosfomycin as a possible first-line agent for the treatment of acute cystitis. PCPs may be misled by advanced patient age, diabetes, and recurrent UTIs to make inappropriate choices for the treatment of acute cystitis. For support in clinical decision making, few providers relied on guidelines, preferring instead to have decision support embedded in the electronic medical record. Knowing the PCPs’ knowledge gaps and preferred sources of information will guide the development of a primary care-specific antibiotic stewardship intervention for acute cystitis.

Urinary tract infections in Australian aged care homes: Antibiotic prescribing practices and concordance to national guidelines

2020 ◽  
Vol 48 (3) ◽  
pp. 261-266 ◽  
Author(s):  
Leslie Dowson ◽  
Noleen Bennett ◽  
Kirsty Buising ◽  
Caroline Marshall ◽  
N. Deborah Friedman ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Aged Care ◽  
Care Homes ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
National Guidelines ◽  
Tract Infections

scholarly journals 1082. Hold the Phone: Antibiotic Prescribing Practices Associated with Nonvisit Encounters for Urinary Tract Infections (UTIs) in Urology Clinics

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S384-S384
Author(s):  
Nina Akbar ◽  
Erica L Dobson ◽  
Michael Keefer ◽  
Sonal Munsiff ◽  
Ghinwa Dumyati
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Treatment Guidelines ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Outpatient Setting ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Medical Provider ◽  
Tract Infections

Abstract Background Surveillance data uncovers a high proportion of multidrug-resistant Gram-negative organisms found in the outpatient setting, often in patients with recurrent urinary tract infections (UTIs), underlying urologic abnormalities, and prior treatment for UTIs. We assessed prescribing practices at urology clinics to identify potential stewardship strategies for UTI management. Methods Antibiotic prescription encounters for adult patients from nine urology clinics were obtained from July to September 2018 using the EHR. We collected encounter types (visit or nonvisit), ordering medical provider types, antibiotic classes and patient demographics. A subset of 50 randomized, unique patient telephone encounters (TEs) was reviewed for documentation of a UTI diagnosis, symptoms, urinalysis and culture results, antibiotic prescriptions and duration. Results A total of 1,704 antibiotic orders were identified for 1,210 patients (48% female, median age 69 years, IQR 20). The majority (75%) of antibiotic encounters were from nonvisits: TEs (39%), orders only (25%), refills (9%), and patient email (2%). Major prescribers were advanced practice providers (APPs, 61%) followed by attending physicians (38%). Antibiotics prescribed were fluoroquinolones (FQs, 27%), nitrofurantoin (24%), first-generation cephalosporins (16%), and trimethoprim–sulfamethoxazole (15%). From the subset of 50 TEs, APPs wrote 76% of prescriptions and 32% of all orders were FQs. Thirty-nine patients had a clinical UTI diagnosis, yet 33% (13/39) did not have documentation of at least one urinary sign or symptom. For symptomatic patients, 15% (4/26) did not have a urine culture result within one week before or after the TE date. The distribution of antibiotics prescribed was similar to overall use and the median duration was 7 days. Conclusion Urology practices care for patients with the most complicated urinary tract pathology and appropriate antibiotic use in this population is a challenge. We found that urology providers often prescribe antibiotics to elderly patients without in-person visits, documentation of symptoms or microbiologic evidence of a UTI. Stewardship efforts should involve APPs, developing diagnostic and treatment guidelines for UTIs and improving documentation for antibiotic orders. Disclosures All authors: No reported disclosures.

scholarly journals Treatment of urinary tract infections in Swiss primary care: quality and determinants of antibiotic prescribing

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Andreas Plate ◽  
Andreas Kronenberg ◽  
Martin Risch ◽  
Yolanda Mueller ◽  
Stefania Di Gangi ◽  
...  
Keyword(s):  
Primary Care ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Care Quality ◽  
Antibiotic Prescribing ◽  
Primary Care Quality ◽  
Tract Infections ◽  
Swiss Primary Care
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