Evaluation of clinicians’ knowledge, attitudes, and planned behaviors related to an intervention to improve acute respiratory infection management

2020 ◽  
Vol 41 (6) ◽  
pp. 672-679 ◽  
Author(s):  
Hayli R. Hruza ◽  
Tania Velasquez ◽  
Karl J. Madaras-Kelly ◽  
Katherine E. Fleming-Dutra ◽  
Matthew H. Samore ◽  
...  
Keyword(s):  
Communication Strategies ◽  
Implementation Strategies ◽  
Patient Communication ◽  
Audit And Feedback ◽  
Antibiotic Prescribing ◽  
Health Administration ◽  
Prescribing Practices ◽  
Diagnostic Uncertainty ◽  
Appropriate Prescribing ◽  
Tract Infections

AbstractBackground:Acute respiratory tract infections (ARIs) are commonly diagnosed and major drivers of antibiotic prescribing. Clinician-focused interventions can reduce unnecessary antibiotic prescribing for ARIs. We elicited clinician feedback to design sustainable interventions to improve ARI management by understanding the mental framework of clinicians surrounding antibiotic prescribing within Veterans’ Health Administration clinics.Methods:We conducted one-on-one interviews with clinicians (n = 20) from clinics targeted for intervention at 5 facilities. The theory of planned behavior guided interview questions. Interviews were audio recorded and transcribed for qualitative analysis. An iterative coding approach identified 6 themes.Results:Emergent themes: (1) barriers to appropriate prescribing are multifactorial and include challenges of behavior change; (2) antibiotic prescribing decisions are perceived as autonomous yet, diagnostic uncertainty and perceptions of patient demand can make prescribing decisions difficult; (3) clinicians perceive variation in peer prescribing practices and influences; (4) clinician-focused interventions are valuable if delivered with sensitivity; (5) communication strategies for educating patients are preferred to a shared decisions process; and (6) team standardization of practice and communication are key to facilitate appropriate prescribing. Clinicians perceived audit-and-feedback with peer comparison, academic detailing, and enhanced patient communication strategies as viable approaches to improving appropriate prescribing.Conclusion:Implementation strategies that enable clinicians to overcome diagnostic uncertainty, perceived patient demand, and improve patient education are desired. Implementation strategies were welcomed, and some were more readily accepted (eg, audit feedback) than others (eg, shared decision making). Implementation strategies should address clinicians’ perceptions of antibiotic prescribing practices and should enhance their patient communication skills.

scholarly journals Development of an Electronic Algorithm to Identify Inappropriate Antibiotic Prescribing for Pediatric Pharyngitis

2020 ◽  
Vol 41 (S1) ◽  
pp. s188-s189
Author(s):  
Jeffrey Gerber ◽  
Robert Grundmeier ◽  
Keith Hamilton ◽  
Lauri Hicks ◽  
Melinda Neuhauser ◽  
...  
Keyword(s):  
Predictive Value ◽  
Gold Standard ◽  
Antibiotic Stewardship ◽  
Chart Review ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Tract Infections ◽  
The Impact

Background: Antibiotic overuse contributes to antibiotic resistance and unnecessary adverse drug effects. Antibiotic stewardship interventions have primarily focused on acute-care settings. Most antibiotic use, however, occurs in outpatients with acute respiratory tract infections such as pharyngitis. The electronic health record (EHR) might provide an effective and efficient tool for outpatient antibiotic stewardship. We aimed to develop and validate an electronic algorithm to identify inappropriate antibiotic use for pediatric outpatients with pharyngitis. Methods: This study was conducted within the Children’s Hospital of Philadelphia (CHOP) Care Network, including 31 pediatric primary care practices and 3 urgent care centers with a shared EHR serving >250,000 children. We used International Classification of Diseases, Tenth Revision (ICD-10) codes to identify encounters for pharyngitis at any CHOP practice from March 15, 2017, to March 14, 2018, excluding those with concurrent infections (eg, otitis media, sinusitis), immunocompromising conditions, or other comorbidities that might influence the need for antibiotics. We randomly selected 450 features for detailed chart abstraction assessing patient demographics as well as practice and prescriber characteristics. Appropriateness of antibiotic use based on chart review served as the gold standard for evaluating the electronic algorithm. Criteria for appropriate use included streptococcal testing, use of penicillin or amoxicillin (absent β-lactam allergy), and a 10-day duration of therapy. Results: In 450 patients, the median age was 8.4 years (IQR, 5.5–9.0) and 54% were women. On chart review, 149 patients (33%) received an antibiotic, of whom 126 had a positive rapid strep result. Thus, based on chart review, 23 subjects (5%) diagnosed with pharyngitis received antibiotics inappropriately. Amoxicillin or penicillin was prescribed for 100 of the 126 children (79%) with a positive rapid strep test. Of the 126 children with a positive test, 114 (90%) received the correct antibiotic: amoxicillin, penicillin, or an appropriate alternative antibiotic due to b-lactam allergy. Duration of treatment was correct for all 126 children. Using the electronic algorithm, the proportion of inappropriate prescribing was 28 of 450 (6%). The test characteristics of the electronic algorithm (compared to gold standard chart review) for identification of inappropriate antibiotic prescribing were sensitivity (99%, 422 of 427); specificity (100%, 23 of 23); positive predictive value (82%, 23 of 28); and negative predictive value (100%, 422 of 422). Conclusions: For children with pharyngitis, an electronic algorithm for identification of inappropriate antibiotic prescribing is highly accurate. Future work should validate this approach in other settings and develop and evaluate the impact of an audit and feedback intervention based on this tool.Funding: NoneDisclosures: None

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 >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 Understanding antibiotic prophylaxis prescribing in pediatric surgical specialties

2020 ◽  
Vol 41 (6) ◽  
pp. 666-671
Author(s):  
Sara M. Malone ◽  
Natalie S. Seigel ◽  
Jason G. Newland ◽  
Jacqueline M. Saito ◽  
Virginia R. McKay
Keyword(s):  
Focus Groups ◽  
Antibiotic Prophylaxis ◽  
Scientific Evidence ◽  
Implementation Strategies ◽  
Interventional Cardiology ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Health Crisis ◽  
Poor Outcomes

AbstractBackground:Overuse of antibiotics has caused secondary poor outcomes and has led to a current rate of antibiotic resistant infections that constitutes a public health crisis. In pediatric surgical specialties, children continue to receive unnecessary antibiotics.Objective:To understand the factors that contribute to pediatric surgeons’ decisions regarding the use of perioperative antibiotic prophylaxis.Methods:Focus groups included pediatric proceduralists/surgeons from the following specialties: interventional cardiology, otolaryngology, orthopedic surgery, cardiothoracic surgery, and general surgery.Results:A total of 23 surgeons with a median of 9 years of experience (range, 0.5–29 years) participated in the focus groups that lasted 30–90 minutes each. Five themes emerged influencing beliefs about antibiotic prescribing practices: (1) reliance on previous experience and early education, (2) balancing antibiotic use with risk of infection, (3) uncertainty about the state of the scientific evidence, (4) understanding importance of communication and team collaboration, and (5) a prevalence of hospital-level concerns.Conclusions:Surgeons describe a complex set of factors that impact their antibiotic prescribing in pediatric surgical cases. They reported initial, but not ongoing, training and a use of individual weight of risk and benefit as a major dictator of prescribing practices. Antimicrobial stewardship programs should work with surgeons to develop acceptable implementation strategies to optimize antibiotic prescribing.

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 Development of an Antimicrobial Stewardship Intervention Using a Model of Actionable Feedback

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Sameer J. Patel ◽  
Lisa Saiman ◽  
Jennifer M. Duchon ◽  
David Evans ◽  
Yu-hui Ferng ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Neonatal Intensive Care ◽  
Laboratory Data ◽  
Antibiotic Use ◽  
Shared Responsibility ◽  
Individual Responsibility ◽  
Audit And Feedback ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Data Elements

We describe the development of an audit and feedback intervention to improve antibiotic prescribing in the neonatal intensive care unit (NICU) using a theoretical framework. Participants included attending physicians, neonatal fellows, pediatric residents, and nurse practitioners. The intervention was based on the “model of actionable feedback” which emphasizes that feedback should be timely, individualized, nonpunitive, and customized to be effective. We found that real-time feedback could not be provided for the parameters established in this study, as we had to collect and analyze numerous data elements to assess appropriate initiation and continuation of antibiotics and required longer intervals to examine trends in antibiotic use. We learned during focus groups that NICU clinicians strongly resisted assigning individual responsibility for antibiotic prescribing as they viewed this as a shared responsibility informed by each patient's laboratory data and clinical course. We were able to create a non-punitive atmosphere thanks to written informed consent from NICU attendings and assurance from leadership that prescribing practices would not be used to assess job performance. We provided customized, meaningful feedback integrating input from the participants. Adapting the principles of the “model of actionable feedback” to provide feedback for antimicrobial prescribing practices proved challenging in the NICU setting.

scholarly journals Antibiotic Prescribing Practices and Errors among Hospitalized Pediatric Patients Suffering from Acute Respiratory Tract Infections: A Multicenter, Cross-Sectional Study in Pakistan

Medicina ◽  
2019 ◽  
Vol 55 (2) ◽  
pp. 44 ◽  
Author(s):  
Sadia Iftikhar ◽  
Muhammad Rehan Sarwar ◽  
Anum Saqib ◽  
Muhammad Sarfraz ◽  
Qurat-ul-ain Shoaib
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Public Hospitals ◽  
P Value ◽  
Antibiotic Prescribing ◽  
Prescribing Errors ◽  
Prescribing Practices ◽  
Cross Sectional ◽  
Acute Respiratory Tract Infections ◽  
Tract Infections

Background and objective: The noncompliance of treatment guidelines by healthcare professionals, along with physiological variations, makes the pediatric population more prone to antibiotic prescribing errors. The present study aims to evaluate the prescribing practices and errors of the most frequently prescribed antibiotics among pediatric patients suffering from acute respiratory tract infections who had different lengths of stay (LOS) in public hospitals. Methods: A retrospective, cross-sectional study was conducted in five tertiary-care public hospitals of Lahore, Pakistan, between 1 January 2017 and 30 June 2017. The study population consisted of pediatric inpatients aged 0 to 9 years. Results: Among the 11,892 pediatric inpatients, 82.8% were suffering from lower acute respiratory tract infections and had long LOS (53.1%) in hospital. Penicillins (52.4%), cephalosporins (16.8%), and macrolides (8.9%) were the most frequently prescribed antibiotics. Overall, 40.8% of the cases had antibiotic prescribing errors related to wrong dose (19.9%), wrong frequency (18.9%), and duplicate therapy (18.1%). Most of these errors were found in the records of patients who had long LOS in hospital (53.1%). Logistic regression analysis revealed that the odds of prescribing errors were lower in female patients (OR = 0.6, 95% CI = 0.1–0.9, p-value = 0.012). Patients who were prescribed with ≥3 antibiotics per prescription (OR = 1.724, 95% CI = 1.1–2.1, p-value = 0.020), had long LOS (OR = 12.5, 95% CI = 10.1–17.6, p-value < 0.001), and were suffering from upper respiratory tract infections (URTI) (OR = 2.8, 95% CI = 1.7–3.9, p-value < 0.001) were more likely to experience prescribing errors. Conclusion: Antibiotics were commonly prescribed to patients who had long LOS. Prescribing errors (wrong dose, wrong frequency, and duplicate therapy) were commonly found in cases of lower respiratory tract infections (LRTIs), especially among those who had prolonged stay in hospital.

scholarly journals Inpatient antibiotic utilization in the Veterans’ Health Administration during the coronavirus disease 2019 (COVID-19) pandemic

2020 ◽  
pp. 1-3 ◽  
Author(s):  
Thomas D. Dieringer ◽  
Daisuke Furukawa ◽  
Christopher J. Graber ◽  
Vanessa W. Stevens ◽  
Makoto M. Jones ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Veterans Health Administration ◽  
Antibiotic Prescribing ◽  
Veterans Health ◽  
Health Administration ◽  
Prescribing Practices ◽  
Antibiotic Utilization ◽  
Days Of Therapy

Abstract Antibiotic prescribing practices across the Veterans’ Health Administration (VA) experienced significant shifts during the coronavirus disease 2019 (COVID-19) pandemic. From 2015 to 2019, antibiotic use between January and May decreased from 638 to 602 days of therapy (DOT) per 1,000 days present (DP), while the corresponding months in 2020 saw antibiotic utilization rise to 628 DOT per 1,000 DP.

Privacy-preserving audit and feedback on the antibiotic prescribing of General Practitioners (Preprint)

2021 ◽  
Author(s):  
Kassaye Yitbarek Yigzaw ◽  
Taridzo Chomutare ◽  
Rolf Wynn ◽  
Gro Karine Rosvold Berntsen ◽  
Johan Gustav Bellika
Keyword(s):  
General Practitioners ◽  
Clinical Performance ◽  
Inappropriate Prescribing ◽  
Public Health Problem ◽  
Privacy Preserving ◽  
Audit And Feedback ◽  
Antibiotic Prescribing ◽  
Clinical Settings ◽  
Tract Infections ◽  
F System

BACKGROUND Antibiotic resistance is a worldwide public health problem that is accelerated by misuse and overuse of antibiotics. Studies have shown that audit and feedback enabling clinicians to compare their clinical performance with their peers is effective in reducing inappropriate prescribing of antibiotics. However, privacy concerns make the audit and feedback hard to implement in clinical settings. Therefore, we have developed a privacy-preserving audit and feedback (A&F). OBJECTIVE The paper aims to evaluate the privacy-preserving audit and feedback (A&F) system in clinical settings. METHODS A privacy-preserving A&F system was deployed in three primary care practices in Norway to generate feedback to twenty General Practitioners (GPs) on their prescribing of antibiotics for selected respiratory tract infections. The GPs were asked to participate in a survey shortly after using the system, and we analysed the data. RESULTS Fourteen GPs responded to the questionnaire, representing a 70% (14/20) response rate. The participants were generally satisfied with usefulness of the feedback and the comparison with peers, as well as protection of privacy. The majority of the GPs value the protection of their own privacy, as well as that of their patients. CONCLUSIONS The system overcomes important privacy and scaling challenges commonly associated with secondary use of electronic health record (EHR) data, and has a potential to improve antibiotic prescribing behaviour; however, further study is required to assess its actual effect.

Impact of a Personalized Audit and Feedback Intervention on Antibiotic Prescribing Practices for Outpatient Pediatric Community-Acquired Pneumonia

2020 ◽  
Vol 59 (11) ◽  
pp. 988-994 ◽  
Author(s):  
Maria Carmen G. Diaz ◽  
Lori K. Handy ◽  
James H. Crutchfield ◽  
Adriana Cadilla ◽  
Jobayer Hossain ◽  
...  
Keyword(s):  
Positive Impact ◽  
Intervention Group ◽  
Primary Care Providers ◽  
Outpatient Setting ◽  
Community Acquired Pneumonia ◽  
Audit And Feedback ◽  
Antibiotic Prescribing ◽  
Care Providers ◽  
Prescribing Practices ◽  
The Impact

Antibiotic choice for pediatric community-acquired pneumonia (CAP) varies widely. We aimed to determine the impact of a 6-month personalized audit and feedback program on primary care providers’ antibiotic prescribing practices for CAP. Participants in the intervention group received monthly personalized feedback. We then analyzed enrolled providers’ CAP antibiotic prescribing practices. Participants diagnosed 316 distinct cases of CAP (214 control, 102 intervention); among these 316 participants, 301 received antibiotics (207 control, 94 intervention). In patients ≥5 years, the intervention group had fewer non–guideline-concordant antibiotics prescribed (22/103 [21.4%] control; 3/51 [5.9%] intervention, P < .05) and received more of the guideline-concordant antibiotics (amoxicillin and azithromycin). Personalized, scheduled audit and feedback in the outpatient setting was feasible and had a positive impact on clinician’s selection of guideline-recommended antibiotics. Audit and feedback should be combined with other antimicrobial stewardship interventions to improve guideline adherence in the management of outpatient CAP.

scholarly journals Delayed prescribing of antibiotics for acute respiratory infections by GP registrars: a qualitative study

2019 ◽  
Vol 37 (3) ◽  
pp. 406-411 ◽  
Author(s):  
Anthea Dallas ◽  
Andrew Davey ◽  
Katie Mulquiney ◽  
Joshua Davis ◽  
Paul Glasziou ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Respiratory Infections ◽  
Antibiotic Use ◽  
Safety Net ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Career Stage ◽  
Diagnostic Uncertainty ◽  
Telephone Interviews ◽  
Tract Infections

Abstract Background Antibiotic prescribing for acute self-limiting respiratory tract infections (ARTIs) in Australia is higher than international benchmarks. Antibiotics have little or no efficacy in these conditions, and unnecessary use contributes to antibiotic resistance. Delayed prescribing has been shown to reduce antibiotic use. GP registrars are at a career-stage when long-term prescribing patterns are being established. Aim To explore experiences, perceptions and attitudes of GP registrars and supervisors to delayed antibiotic prescribing for ARTIs. Design and setting A qualitative study of Australian GP registrars and supervisors using a thematic analysis approach. Method GP registrars and supervisors were recruited across three Australian states/territories, using maximum variation sampling. Telephone interviews explored participants’ experience and perceptions of delayed prescribing of antibiotics in ARTIs. Data collection and analysis were concurrent and iterative. Results A total of 12 registrars and 10 supervisors were interviewed. Key themes included the use of delayed prescribing as a safety-net in cases of diagnostic uncertainty or when clinical review was logistically difficult. Delayed prescribing was viewed as a method of educating and empowering patients, and building trust and the doctor–patient relationship. Conversely, it was also seen as a loss of control over management decisions. Supervisors, more so than registrars, appreciated the psychosocial complexity of ARTI consultations and the importance of delayed antibiotic prescribing in this context. Conclusion Better awareness and understanding by GP registrars of the evidence for delayed antibiotic prescription may be a means of reducing antibiotic prescribing. Understanding both registrar and supervisor usage, uncertainties and attitudes should inform educational approaches on this topic.

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