scholarly journals Utilizing Behavioral Science to Improve Antibiotic Prescribing in Rural Urgent Care Settings

2020 ◽  
Vol 7 (7) ◽  
Author(s):  
Patricia L Cummings ◽  
Rita Alajajian ◽  
Larissa S May ◽  
Russel Grant ◽  
Hailey Greer ◽  
...  
Keyword(s):  
Behavioral Interventions ◽  
Inappropriate Prescribing ◽  
The United States ◽  
Urgent Care ◽  
Resistant Bacteria ◽  
Antibiotic Prescribing ◽  
Intervention Period ◽  
Its Analysis ◽  
Tract Infections ◽  
Inappropriate Prescriptions

Abstract Background Antibiotic-inappropriate prescribing for acute respiratory tract infections (ARTI) is 45% among urgent care centers (UCCs) in the United States. Locally in our UCCs, antibiotic-inappropriate prescribing for ARTI is higher—over 70%. Methods We used a quasi-experimental design to implement 3 behavioral interventions targeting antibiotic-inappropriate/non-guideline-concordant prescribing for ARTI at 3 high-volume rural UCCs and analyzed prescribing rates pre- and post-intervention. The 3 interventions were (1) staff/patient education, (2) public commitment, and (3) peer comparison. For peer comparison, providers were sent feedback emails with their prescribing data during the intervention period and a blinded ranking email comparing them with their peers. Providers were categorized as “low prescribers” (ie,  ≤23% antibiotic-inappropriate prescriptions based off the US National Action Plan for Combating Antibiotic Resistant Bacteria 2020 goal) or “high prescribers” (ie,  ≥45%—the national average of antibiotic-inappropriate prescribing for ARTI). An interrupted time series (ITS) analysis compared prescribing for ARTI (the primary outcome) over a 16-month period before the intervention and during the 6-month intervention period, for a total of 22 months, across the 3 UCCs. Results Fewer antibiotic-inappropriate prescriptions were written during the intervention period (57.7%) compared with the pre-intervention period (72.6%) in the 3 UCCs, resulting in a 14.9% absolute decrease in percentage of antibiotic-inappropriate prescriptions. The ITS analysis revealed that the rate of antibiotic-inappropriate prescribing was statistically significantly different pre-intervention compared with the intervention period (95% confidence interval, –4.59 to –0.59; P = .014). Conclusions In this sample of rural UCCs, we reduced antibiotic-inappropriate prescribing for ARTI using 3 behavioral interventions.

scholarly journals Utilizing Behavioral Science to Improve Antibiotic Prescribing in Rural Urgent Care Settings

2020 ◽  
Vol 41 (S1) ◽  
pp. s506-s507
Author(s):  
Patricia Cummings ◽  
Rita Alajajian ◽  
Larissa May ◽  
Russel Grant ◽  
Hailey Greer ◽  
...  
Keyword(s):  
Patient Education ◽  
Influenza Season ◽  
Action Plan ◽  
Inappropriate Prescribing ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Intervention Period ◽  
National Action Plan ◽  
Its Analysis ◽  
Urgent Care Centers

Background: The rate of inappropriate antibiotic prescribing for acute respiratory tract infections (ARTIs) is 45% among urgent care centers across the United States. To contribute to the US National Action Plan for Combating Antibiotic-Resistant Bacteria, which aims to decrease rates of inappropriate prescribing, we implemented 2 behavioral nudges using the evidence-based MITIGATE tool kit from urgent-care settings, at 3 high-volume, rural, urgent-care centers. Methods: An interrupted time series (ITS) analysis was conducted comparing a preintervention phase during the 2017–2018 influenza season (October through March) to the intervention phase during the 2018–2019 influenza season. We compared the rate of inappropriate or non–guideline-concordant antibiotic prescribing for ARTIs across 3 urgent-care locations. The 2 intervention behavioral nudges were (1) staff and patient education and (2) peer comparison. Provider education included presentations at staff meetings and grand rounds, and patient education print materials were distributed to the 3 locations coupled with news media and social media. We utilized the CDC “Be Antibiotics Aware” campaign materials, with our hospital’s logo added, and posted them in patient rooms and waiting areas. For the peer comparison behavioral intervention, providers were sent individual feedback e-mails with their prescribing data during the intervention period and a blinded ranking e-mail in which they were ranked in comparison to their peers. In the blinded ranking email, providers were placed into categories of “low prescribers,” those with a ≤23% inappropriate antibiotic prescribing rate based on the US National Action Plan for Combating Antibiotic-Resistance Bacteria 2020 goal, or “high prescribers,” those with a rate greater than the national average (45%) of inappropriate antibiotic prescribing for ARTI. Results: Our results show that fewer inappropriate antibiotic prescriptions were written during the intervention period (58.8%) than during the preintervention period (73.0%), resulting in a 14.5% absolute decrease in rates of inappropriate prescribing among urgent-care locations over a 6-month period (Fig. 1). The largest percentage decline in rates was seen in the month of April (−35.8%) when compared to April of the previous year. The ITS analysis revealed that the rate of inappropriate prescribing was statistically significantly different during the preintervention period compared to the intervention period (95% CI, −4.59 to −0.59; P = .0142). Conclusions: Using interventions outlined in the MITIGATE tool kit, we were able to reduce inappropriate antibiotic prescribing for ARTI in 3 rural, urgent-care locations.Funding: NoneDisclosures: Larissa May repo, Speaking honoraria-Cepheid Research grants-Roche Consultant-BioRad Advisory Board-Qvella Consultant-Nabriva

scholarly journals 142. Implementing an Antimicrobial Stewardship Program in the Outpatient Setting

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S82-S82
Author(s):  
Travis B Nielsen ◽  
Maressa Santarossa ◽  
Beatrice D Probst ◽  
Laurie Labuszewski ◽  
Jenna Lopez ◽  
...  
Keyword(s):  
Primary Care ◽  
Antimicrobial Stewardship ◽  
Inappropriate Prescribing ◽  
The United States ◽  
Outpatient Setting ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Antimicrobial Stewardship Program ◽  
Post Intervention ◽  
Stewardship Program

Abstract Background Antimicrobial-resistant infections lead to increased morbidity, mortality, and healthcare costs. Among the most facile modifiable risk factors for developing resistance is inappropriate prescribing. The CDC estimates that 47 million (or ≥30% of) outpatient antibiotic prescriptions in the United States are unnecessary. This has provided impetus for expanding our antimicrobial stewardship program (ASP) into the outpatient setting. Initial goals included the following: continuous evaluation and reporting of antibiotic prescribing compliance; minimize underuse of antibiotics from delayed diagnoses and misdiagnoses; ensure proper drug, dose, and duration; improve the percentage of appropriate prescriptions. Methods To achieve these goals, we first sent a baseline survey to outpatient prescribers, assessing their understanding of stewardship and antimicrobial resistance. Questions were modeled from the Illinois Department of Public Health (IDPH) Precious Drugs & Scary Bugs Campaign. The survey was sent to prescribers at 19 primary care and three immediate/urgent care clinics. Compliance rates for prescribing habits were subsequently tracked via electronic health records and reported to prescribers in accordance with IRB approval. Results Prescribers were highly knowledgeable about what constitutes appropriate prescribing, with verified compliance rates highly concordant with self-reported rates. However, 74% of respondents reported intense pressure from patients to inappropriately prescribe antimicrobials. Compliance rates have been tracked since December 2018 and comparing pre- with post-intervention rates shows improvement in primary care since reporting rates to prescribers in August 2019. Conclusion Reporting compliance rates has been helpful in avoiding inappropriate antimicrobial therapy. However, the survey data reinforce the importance of behavioral interventions to bolster ASP efficacy in the outpatient setting. Going forward, posters modeled off of the IDPH template will be conspicuously exhibited in exam rooms, indicating institutional commitment to the enumerated ASP guidelines. Future studies will allow for comparison of pre- and post-intervention knowledge and prescriber compliance. Disclosures All Authors: No reported disclosures

Pharmacist-Driven Implementation of Outpatient Antibiotic Prescribing Algorithms Improves Guideline Adherence in the Emergency Department

2020 ◽  
pp. 089719002093097
Author(s):  
Kristin Stoll ◽  
Erik Feltz ◽  
Steven Ebert
Keyword(s):  
Emergency Department ◽  
Clinical Practice ◽  
Guideline Adherence ◽  
Inappropriate Prescribing ◽  
Community Acquired Pneumonia ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Duration Of Therapy ◽  
Tract Infections ◽  
Selection Of

Background: Inappropriate prescribing of antibiotics has been identified as the most important modifiable risk factor for antimicrobial resistance. Objective: The purpose of this project was to improve guideline adherence and promote optimal use of outpatient antibiotics in the emergency department (ED). Methods: Prescribing algorithms for community-acquired pneumonia (CAP), skin and soft tissue infections (SSTI), and urinary tract infections (UTI) were developed to integrate clinical practice guideline recommendations with local ED antibiogram data. Outcomes were evaluated through chart review of patients prescribed outpatient antibiotics by ED providers. The primary outcome was adherence to clinical practice guidelines, defined as the selection of an appropriate antibiotic agent, dose, and duration of therapy for each patient discharged. Results: When compared to patients discharged from the ED prior to algorithm implementation (N = 325), the post-implementation group (N = 353) received more antibiotic prescriptions that were completely guideline adherent (61.5% vs 11.7%, P < .00001). Post-implementation discharge orders demonstrated improvement in the selection of an appropriate agent (87.3% vs 45.5%, P < .00001), dose (91.5% vs 77.2%, P < .00001), and duration of therapy (71.1% vs 39.1%, P < .01). Additionally, fluoroquinolone prescribing rates were reduced (2.3% vs 12.3%, P < .00001). A reduction in all-cause 30-day returns to the ED or urgent care was observed (15.3% vs 21.5%, P = .036). Conclusion: Pharmacist-driven implementation of antibiotic prescribing algorithms improved guideline adherence in the outpatient treatment of CAP, SSTI, and UTI.

scholarly journals Outpatient Antibiotic Prescription Trends in the United States: A National Cohort Study

2018 ◽  
Vol 39 (5) ◽  
pp. 584-589 ◽  
Author(s):  
Michael J. Durkin ◽  
S. Reza Jafarzadeh ◽  
Kevin Hsueh ◽  
Ya Haddy Sallah ◽  
Kiraat D. Munshi ◽  
...  
Keyword(s):  
United States ◽  
Inappropriate Prescribing ◽  
The United States ◽  
Antibiotic Consumption ◽  
Antibiotic Prescribing ◽  
Administrative Claims ◽  
Upper Respiratory Tract ◽  
Prescribing Practices ◽  
Amoxicillin Clavulanate ◽  
Tract Infections

OBJECTIVETo characterize trends in outpatient antibiotic prescriptions in the United StatesDESIGNRetrospective ecological and temporal trend study evaluating outpatient antibiotic prescriptions from 2013 to 2015SETTINGNational administrative claims data from a pharmacy benefits manager PARTICIPANTS. Prescription pharmacy beneficiaries from Express Scripts Holding CompanyMEASUREMENTSAnnual and seasonal percent change in antibiotic prescriptionsRESULTSApproximately 98 million outpatient antibiotic prescriptions were filled by 39 million insurance beneficiaries during the 3-year study period. The most commonly prescribed antibiotics were azithromycin, amoxicillin, amoxicillin/clavulanate, ciprofloxacin, and cephalexin. No significant changes in individual or overall annual antibiotic prescribing rates were found during the study period. Significant seasonal variation was observed, with antibiotics being 42% more likely to be prescribed during February than September (peak-to-trough ratio [PTTR], 1.42; 95% confidence interval [CI], 1.39–1.61). Similar seasonal trends were found for azithromycin (PTTR, 2.46; 95% CI, 2.44–3.47), amoxicillin (PTTR, 1.52; 95% CI, 1.42–1.89), and amoxicillin/clavulanate (PTTR, 1.78; 95% CI, 1.68–2.29).CONCLUSIONSThis study demonstrates that annual national outpatient antibiotic prescribing practices remained unchanged during our study period. Furthermore, seasonal peaks in antibiotics generally used to treat viral upper respiratory tract infections remained unchanged during cold and influenza season. These results suggest that inappropriate prescribing of antibiotics remains widespread, despite the concurrent release of several guideline-based best practices intended to reduce inappropriate antibiotic consumption; however, further research linking national outpatient antibiotic prescriptions to associated medical conditions is needed to confirm these findings.Infect Control Hosp Epidemiol 2018;39:584–589

scholarly journals Primary Care Physicians’ Attitudes and Perceptions Towards Antibiotic Resistance and Antibiotic Stewardship: A National Survey

2020 ◽  
Vol 7 (7) ◽  
Author(s):  
Rachel M Zetts ◽  
Andrea M Garcia ◽  
Jason N Doctor ◽  
Jeffrey S Gerber ◽  
Jeffrey A Linder ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Antibiotic Resistance ◽  
Antibiotic Stewardship ◽  
Primary Care Physicians ◽  
Inappropriate Prescribing ◽  
The United States ◽  
Vaccine Hesitancy ◽  
Resistant Bacteria ◽  
Antibiotic Prescribing

Abstract Background Outpatient antibiotic stewardship is needed to reduce inappropriate prescribing and minimize the development of resistant bacteria. We assessed primary care physicians’ perceptions of antibiotic resistance, antibiotic use, and the need for stewardship activities. Methods We conducted a national online survey of 1550 internal, family, and pediatric medicine physicians in the United States recruited from an opt-in panel of healthcare professionals. Descriptive statistics were generated for respondent demographics and question responses. Responses were also stratified by geographic region and medical specialty, with a χ 2 test used to assess for differences. Results More respondents agreed that antibiotic resistance was a problem in the United States (94%) than in their practice (55%) and that inappropriate antibiotic prescribing was a problem in outpatient settings (91%) than in their practice (37%). In addition, 60% agreed that they prescribed antibiotics more appropriately than their peers. Most respondents (91%) believed that antibiotic stewardship was appropriate in office-based practices, but they ranked antibiotic resistance as less important than other public health issues such as obesity, diabetes, opioids, smoking, and vaccine hesitancy. Approximately half (47%) believed they would need a lot of help to implement stewardship. Respondents indicated that they were likely to implement antibiotic stewardship efforts in response to feedback or incentives provided by payers or health departments. Conclusions Primary care physicians generally did not recognize antibiotic resistance and inappropriate prescribing as issues in their practice. This poses a challenge for the success of outpatient stewardship. Healthcare stakeholders will need to explore opportunities for feedback and incentive activities to encourage stewardship uptake.

scholarly journals Interrupted Time-Series Analysis to Evaluate the Impact of a Behavioral Change Outpatient Antibiotic Stewardship Intervention

2021 ◽  
Vol 1 (S1) ◽  
pp. s15-s16
Author(s):  
Brittany Morgan ◽  
Larissa May ◽  
Haylee Bettencourt
Keyword(s):  
Quality Improvement ◽  
Antibiotic Stewardship ◽  
Respiratory Infections ◽  
Inappropriate Prescribing ◽  
The United States ◽  
Quality Improvement Intervention ◽  
Antibiotic Prescribing ◽  
The Impact ◽  
Improvement Intervention ◽  
Inappropriate Prescriptions

Background: The Centers for Disease Control and Prevention (CDC) estimates that outpatient settings account for 85%–90% of antibiotic prescriptions in the United States, and ~30% of those prescriptions are unnecessary. One of the most common examples of inappropriate prescribing is for viral upper respiratory infections (URIs). Up to 50% of prescriptions written for URIs are deemed inappropriate, making it an important focus for Antibiotic Stewardship programs. In this study, we evaluated the effect of a behaviorally enhanced quality improvement intervention in reducing inappropriate antibiotic prescribing for viral URIs. Methods: A quasi-experimental study assessed the effects of an Antibiotic Stewardship intervention on antibiotic prescribing for viral URIs. The outcome of interest was a change in the number of antibiotics prescribed at each participating clinic over a 1-year preimplementation period and a 2-year postimplementation period. Time trends were analyzed using segmented regression analysis, and a stepped wedge design was used to account for intervention roll-out across clinics. Results: From 2017 to 2020, there were 63,028 patient visits in 21 clinic locations. Antibiotics were prescribed an average of 11.5% and 5.8% of visits during the pre- and postimplementation periods, respectively. The most frequently prescribed antibiotic over the study period was azithromycin (n = 3,551), followed by amoxicillin (n = 924). Overall, the intervention was associated with a 46% reduction in antibiotic prescriptions or 0.54 times (P = .001) as many inappropriate antibiotics prescribed as before the intervention. There was no significant change in the month-to-month trend in inappropriate prescriptions after the intervention was implemented (P = .87). Conclusions: Our study demonstrates that a behaviorally enhanced quality improvement intervention to reduce inappropriate prescribing for URI in ambulatory care encounters was successful in reducing potentially inappropriate prescriptions for presumed viral respiratory infections.Funding: NoDisclosures: None

scholarly journals 1113. Outpatient Antimicrobial Stewardship: Targets for Urinary Tract Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S396-S396
Author(s):  
Kari A Mergenhagen ◽  
Bethany A Wattengel ◽  
Sara DiTursi ◽  
Jennifer Schroeck ◽  
John A Sellick
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Antimicrobial Stewardship ◽  
Urine Culture ◽  
Inappropriate Prescribing ◽  
Retrospective Chart Review ◽  
The United States ◽  
Multivariate Logistic Regression Model ◽  
Antibiotic Prescribing ◽  
Tract Infections

Abstract Background Urinary tract infections (UTIs) remain one of the most commonly diagnosed infectious diseases in the United States in both the inpatient and outpatient settings, accounting for 10.5 million outpatient visits in 2007. Of these visits, 5.4 million were seen in primary care offices. Outpatient antimicrobial stewardship programs are emerging and a focused approach to UTIs is needed to help guide new programs. Methods Data were collected by retrospective chart review of outpatient males at the VA Western New York Healthcare System using encounters from January 2005 to March 2018. Appropriate treatment was defined as antimicrobial prescribing in the setting of at least 2 signs/symptoms of UTI. Categorical data were analyzed using the chi-square test and continuous data using the Student t-test. Factors that differed significantly (P < 0.05) between the comparator groups were built into a multivariate logistic regression model to determine factors associated with inappropriate prescribing, which were presented as an Odds Ratio (OR) and 95% Confidence Interval (CI). Results A total of 607 outpatients met criteria for inclusion, of which 40% were treated inappropriately. Of the 60% treated appropriately (therapy was indicated and empiric drug choice was correct), 95% of patients received a correct dose and 57% received an appropriate duration. Several risk factors were identified for inappropriate prescribing. Female patients were more likely to be treated inappropriately, OR 4.7 (95% CI, 2.4–9.1). Patients with a higher Charlson Comorbidity Index of 5–10 were 2.9 times more likely to be treated inappropriately (95% CI, 1.8–5.0). Those patients who received a urine culture or imaging were more likely to be treated appropriately: OR 0.6 (95% CI, 0.4–0.9) and 0.5 (95% CI, 0.3–0.7), respectively. Conclusion Outpatient antibiotic prescribing for UTIs is suboptimal. Outpatient stewardship programs may wish to educate providers on symptoms of UTI. Interestingly, those with signs and symptoms consistent with UTI were more likely to have a urine culture and/or imaging completed suggesting that providers were aware of a true diagnosis of a UTI. Stewardship programs should pay special attention to patients with numerous comorbidities as they are often inappropriately treated. Disclosures All authors: No reported disclosures.

scholarly journals 220. Comparing Antibiotic Prescription Practices, and Provider’s Perceptions of Such Rates, Among Urgent Care and Non-Urgent Care Clinicians at One of the Nation’s Largest Federally Qualified Health Centers

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S111-S112
Author(s):  
Ramzi W Ben-Yelles ◽  
Brittany Hopkins ◽  
Sherrill Brown ◽  
Sonali Saluja
Keyword(s):  
Antibiotic Prescription ◽  
Inappropriate Prescribing ◽  
The United States ◽  
Health Centers ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Care Providers ◽  
Prescribing Practices ◽  
Federally Qualified Health Centers ◽  
Prescription Practices

Abstract Background Inappropriate antibiotic prescribing practices, and the resulting development of antibiotic resistance, contribute to a growing health emergency worldwide. In reviewing data from 2010–2011, it was estimated that over 30% of ambulatory antibiotic prescriptions in the United States are non-essential.1 Altamed, one of the nation’s largest federally qualified health centers, operates 21 clinics across Southern California and serves the primary care needs of a high-volume, socioeconomically disadvantaged, predominantly Hispanic population. Citation 1 Methods We conducted an evaluation on the inappropriate antibiotic prescribing rate for Upper Respiratory Infections (URI) among all providers at Altamed (n=400). We limited our scope of encounters to cases of uncomplicated, acute bronchitis (URI) that occurred between January and December 2018. ICD 10 codes identified URIs, with exclusion criteria limiting confounding variables, charting errors, and dual diagnoses. Additionally, provider perceptions and mechanism for their antibiotic prescription practices were assessed with a de-identified 17 question, Likert-scale assessment (n=90). Results Of the encounters for URI seen by urgent care providers, 11.09% had inappropriate antibiotic prescriptions written. This is significantly different from encounters by non-urgent care providers, where 9.13% were deemed inappropriate (p=0.016). Despite this, providers were not uniform in believing their own antibiotic prescription rates to be as successful, with many estimating that their rate of CDC guideline concordance to fall below 90%. However, in their survey responses, providers as a whole report following healthy prescribing practices, identifying needs in their communities to recognize when it was inappropriate to prescribe an antibiotic, though they requested increased access to and education on antibiograms. Graph 1 Table 1 Graph 2 Conclusion Our study limitations included uneven or incomplete charting, the narrow time frame of the study, and the limited survey response rate of Altamed providers. Nevertheless, we are able to ascertain that inappropriate prescribing practices continue to be a challenge in the outpatient setting and are of greater concern among urgent care providers. Disclosures All Authors: No reported disclosures

scholarly journals 131. Antimicrobial Usage for Respiratory Infections in Urgent Care Settings within the University of Washington Medicine Network

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S77-S77
Author(s):  
Joanne Huang ◽  
Zahra Kassamali Escobar ◽  
Rupali Jain ◽  
Jeannie D Chan ◽  
John B Lynch ◽  
...  
Keyword(s):  
Adverse Drug Events ◽  
Respiratory Infections ◽  
Inappropriate Prescribing ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
University Of Washington ◽  
Tract Infections ◽  
Viral Respiratory Infections ◽  
Viral Respiratory

Abstract Background In an effort to combat antimicrobial resistance and adverse drug events, The Joint Commission mandated expansion of antimicrobial stewardship programs into ambulatory healthcare settings Jan 2020. The most common diagnoses resulting in inappropriate antimicrobial prescribing are respiratory infections. This study aimed to assess the rate of antibiotic prescribing for viral respiratory tract infections within six urgent care clinics affiliated with University of Washington Medicine health system in Seattle, WA. Methods This was a retrospective observational study from Jan 2019-Feb 2020. We used the MITIGATE toolkit; a resource that meets CDC’s core elements for outpatient stewardship. Patients were identified based upon pre-specified ICD-10 codes for viral respiratory infections. The primary outcome was the rate of unnecessary antimicrobial prescriptions for acute viral respiratory infections. Secondary outcomes evaluated inappropriate prescribing practices based on antibiotic selection, diagnosis, and age. Results Of 7,313 patients (6078 adults and 1235 pediatric) included, 23% were inappropriately prescribed antibiotics. The most common antibiotics inappropriately prescribed were azithromycin (62%), amoxicillin (13%), and doxycycline (13%). Fluoroquinolone (FQ) utilization was low (2%). Bronchitis (61%) and nonsuppurative otitis media (NSOM) (24%) were the most common viral diagnoses for which antibiotics were prescribed. Overall, unnecessary prescribing was lower in pediatrics than adults at 13% and 25%, respectively (p&lt; 0.001). Adults were more often prescribed antibiotics inappropriately for bronchitis and NSOM compared to pediatrics (p=0.0013). Conclusion Inappropriate prescribing practices across six urgent care clinics varied based upon age and diagnosis. Azithromycin is most often inappropriately prescribed but the low rate of FQ prescribing is encouraging. The lower rate of unnecessary prescribing in pediatrics is promising although there is room for improvement as 1 in 8 children were unnecessarily prescribed antibiotics. These findings support the need for antibiotic stewardship in the outpatient setting, targeting areas for azithromycin use and therapeutic management of bronchitis. Disclosures All Authors: No reported disclosures

scholarly journals 145. Monthly Antibiotic Prescribing Peer Comparison Combined with In-person Education Decreases Antibiotic Prescribing for Acute Respiratory Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S83-S83
Author(s):  
Shelby J Kolo ◽  
David J Taber ◽  
Ronald G Washburn ◽  
Katherine A Pleasants
Keyword(s):  
Primary Care ◽  
Respiratory Infections ◽  
Primary Care Providers ◽  
The United States ◽  
Delivery Mode ◽  
Antibiotic Prescribing ◽  
Acute Respiratory Infections ◽  
Care Providers ◽  
Intervention Period ◽  
Provider Education

Abstract Background Inappropriate antibiotic prescribing is an important modifiable risk factor for antibiotic resistance. Approximately half of all antibiotics prescribed for acute respiratory infections (ARIs) in the United States may be inappropriate or unnecessary. The purpose of this quality improvement (QI) project was to evaluate the effect of three consecutive interventions on improving antibiotic prescribing for ARIs (i.e., pharyngitis, rhinosinusitis, bronchitis, common cold). Methods This was a pre-post analysis of an antimicrobial stewardship QI initiative to improve antibiotic prescribing for ARIs in six Veterans Affairs (VA) primary care clinics. Three distinct intervention phases occurred. Educational interventions included training on appropriate antibiotic prescribing for ARIs. During the first intervention period (8/2017-1/2019), education was presented virtually to primary care providers on a single occasion. In the second intervention period (2/2019-10/2019), in-person education with peer comparison was presented on a single occasion. In the third intervention period (11/2019-4/2020), education and prescribing feedback with peer comparison was presented once in-person followed by monthly emails of prescribing feedback with peer comparison. January 2016-July 2017 was used as a pre-intervention baseline period. The primary outcome was the antibiotic prescribing rate for all classifications of ARIs. Secondary outcomes included adherence to antibiotic prescribing guidance for pharyngitis and rhinosinusitis. Descriptive statistics and interrupted time series segmented regression were used to analyze the outcomes. Results Monthly antibiotic prescribing peer comparison emails in combination with in-person education was associated with a statistically significant 12.5% reduction in the rate of antibiotic prescribing for ARIs (p=0.0019). When provider education alone was used, the reduction in antibiotic prescribing was nonsignificant. Conclusion Education alone does not significantly reduce antibiotic prescribing for ARIs, regardless of the delivery mode. In contrast, education followed by monthly prescribing feedback with peer comparison was associated with a statistically significant reduction in ARI antibiotic prescribing rates. Disclosures All Authors: No reported disclosures

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