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= < 0.0001). Patients treated via office visits were more likely to have a urinalysis (0% vs 97.1%; P < 0.001) and urine culture (0% vs 73.1%; P < 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 < 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 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 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 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.

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

scholarly journals A Descriptive Analysis of Outpatient Antimicrobial Use for Urinary Tract Infections in Virginia

2020 ◽  
Vol 41 (S1) ◽  
pp. s453-s454
Author(s):  
Hasti Mazdeyasna ◽  
Shaina Bernard ◽  
Le Kang ◽  
Emily Godbout ◽  
Kimberly Lee ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Private Insurance ◽  
Geographic Region ◽  
Study Cohort ◽  
Antibiotic Prescribing ◽  
Prescribing Trends ◽  
Icd 10 ◽  
Tract Infections ◽  
Insurance Payer

Background: Data regarding outpatient antibiotic prescribing for urinary tract infections (UTIs) are limited, and they have never been formally summarized in Virginia. Objective: We describe outpatient antibiotic prescribing trends for UTIs based on gender, age, geographic region, insurance payer and International Classification of Disease, Tenth Revision (ICD-10) codes in Virginia. Methods: We used the Virginia All-Payer Claims Database (APCD), administered by Virginia Health Information (VHI), which holds data for Medicare, Medicaid, and private insurance. The study cohort included Virginia residents who had a primary diagnosis of UTI, had an antibiotic claim 0–3 days after the date of the diagnosis and who were seen in an outpatient facility in Virginia between January 1, 2016, and December 31, 2016. A diagnosis of UTI was categorized as cystitis, urethritis or pyelonephritis and was defined using the following ICD-10 codes: N30.0, N30.00, N30.01, N30.9, N30.90, N30.91, N39.0, N34.1, N34.2, and N10. The following antibiotics were prescribed: aminoglycosides, sulfamethoxazole/trimethoprim (TMP-SMX), cephalosporins, fluoroquinolones, macrolides, penicillins, tetracyclines, or nitrofurantoin. Patients were categorized based on gender, age, location, insurance payer and UTI type. We used χ2 and Cochran-Mantel-Haenszel testing. Analyses were performed in SAS version 9.4 software (SAS Institute, Cary, NC). Results: In total, 15,580 patients were included in this study. Prescriptions for antibiotics by drug class differed significantly by gender (P < .0001), age (P < .0001), geographic region (P < .0001), insurance payer (P < .0001), and UTI type (P < .0001). Cephalosporins were prescribed more often to women (32.48%, 4,173 of 12,846) than to men (26.26%, 718 of 2,734), and fluoroquinolones were prescribed more often to men (53.88%, 1,473 of 2,734) than to women (47.91%, 6,155 of 12,846). Although cephalosporins were prescribed most frequently (42.58%, 557 of 1,308) in northern Virginia, fluoroquinolones were prescribed the most in eastern Virginia (50.76%, 1677 of 3,304). Patients with commercial health insurance, Medicaid, and Medicare were prescribed fluoroquinolones (39.31%, 1,149 of 2,923), cephalosporins (56.33%, 1,326 of 2,354), and fluoroquinolones (57.36%, 5,910 of 10,303) most frequently, respectively. Conclusions: Antibiotic prescribing trends for UTIs varied by gender, age, geographic region, payer status and UTI type in the state of Virginia. These data will inform future statewide antimicrobial stewardship efforts.Funding: NoneDisclosures: Michelle Doll reports a research grant from Molnlycke Healthcare.

scholarly journals Changes in the management of urinary tract infections in women: impact of the new recommendations on antibiotic prescribing behavior in France, between 2014 and 2019

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Arthur Piraux ◽  
Sébastien Faure ◽  
Kurt G. Naber ◽  
Jakhongir F. Alidjanov ◽  
Aline Ramond-Roquin
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Secondary Care ◽  
Administrative Database ◽  
Community Pharmacies ◽  
Antibiotic Prescribing ◽  
Prescribing Behavior ◽  
Using Data ◽  
New Guidelines ◽  
Tract Infections

Abstract Background Urinary tract infections (UTIs) are among the most common infections that require antibiotic therapy. In December 2015, new guidelines for UTI management were published in France with the aim of reducing antibiotic misuse and the risk of antimicrobial resistance. Objectives To analyze changes in antibiotic prescribing behavior for acute uncomplicated UTI in women in France from 2014 to 2019. Methods Retrospective study using data extracted from the medico-administrative database ‘OpenMedic’ that is linked to the French National Health Data System and collects data on the reimbursement of prescribed drugs. The analyses focused on the number of boxes of antibiotics delivered by community pharmacies, the molecule class, and the prescriber’s specialty. Results Overall, antibiotic dispensing by community pharmacies increased by 2% between 2014 and 2019, but with differences in function of the antibiotic class. The use of antibiotics recommended as first-line and second-line treatment increased (+ 41% for fosfomycin and + 7430% for pivmecillinam). Conversely, the dispensing of lomefloxacin and norfloxacin decreased by 80%, and that of ciprofloxacin by 26%. Some antibiotics were mostly prescribed by general practitioners (lomefloxacin, pivmecillinam) and others by secondary care physicians (ofloxacin). Dispensing increased for antibiotics prescribed by secondary care physicians (+ 13% between 2014 and 2019) and decreased for antibiotics prescribed by GPs (− 2% for the same period). Conclusion These data suggest that the new recommendations are followed, as indicated by the increased prescription of fosfomycin and pivmecillinam and decreased prescription of fluoroquinolones. However, the efficient transmission and implementation of new recommendations by practitioners requires time, means and dedicated tools.

scholarly journals Measuring Antibiotic Appropriateness for Urinary Tract Infections in Nursing Home Residents

2017 ◽  
Vol 38 (8) ◽  
pp. 998-1001 ◽  
Author(s):  
Taniece Eure ◽  
Lisa L. LaPlace ◽  
Richard Melchreit ◽  
Meghan Maloney ◽  
Ruth Lynfield ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Nursing Home ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
Nursing Home Residents ◽  
Infect Control Hosp ◽  
Antibiotic Prescribing ◽  
Appropriate Use ◽  
Tract Infections

We assessed the appropriateness of initiating antibiotics in 49 nursing home (NH) residents receiving antibiotics for urinary tract infection (UTI) using 3 published algorithms. Overall, 16 residents (32%) received prophylaxis, and among the 33 receiving treatment, the percentage of appropriate use ranged from 15% to 45%. Opportunities exist for improving UTI antibiotic prescribing in NH.Infect Control Hosp Epidemiol 2017;38:998–1001

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