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 < .001). Additionally, patients who completed virtual visits were less likely to receive antibiotics (68.6% vs 94.3%; P < .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 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 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

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 Knowledge, Attitudes, and Reported Practices Among Obstetrician-Gynecologists in the USA Regarding Antibiotic Prescribing for Upper Respiratory Tract Infections

2005 ◽  
Vol 13 (1) ◽  
pp. 17-24 ◽  
Author(s):  
Shadi Chamany ◽  
Jay Schulkin ◽  
Charles E. Rose ◽  
Laura E. Riley ◽  
Richard E. Besser
Keyword(s):  
Primary Care ◽  
Respiratory Tract Infections ◽  
Antibiotic Use ◽  
Upper Respiratory Tract Infections ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
Office Visits ◽  
The Common ◽  
Upper Respiratory ◽  
Tract Infections

Background:Knowledge, attitudes, and practices regarding antibiotic prescribing for upper respiratory tract infections (URIs) have not been well described among obstetrician-gynecologists (OB/GYNs). This information is useful for determining whether an OB/GYN-specific program promoting appropriate antibiotic use would significantly contribute to the efforts to decrease inappropriate antibiotic use among primary care providers.Methods:An anonymous questionnaire asking about the treatment of URIs was sent to 1031 obstetrician-gynecologists.Results:The overall response rate was 46%. The majority of respondents (92%) were aware of the relationship between antibiotic use and antibiotic resistance, and respondents estimated that 5% of their patients had URI symptoms at their office visits. Overall, 56% of respondents reported that they would prescribe an antibiotic for uncomplicated bronchitis and 43% for the common cold. OB/GYNs with the fewest years of experience were less likely than those with the most years of experience to report prescribing for uncomplicated bronchitis (Odds ratio (OR) 0.46, 95% confidence interval (CI) 0.23 to 0.91) or the common cold (OR 0.44, CI 0.22 to 0.89). The majority of respondents (60%) believed that most patients wanted an antibiotic for URI symptoms, with male OB/GYNs being more likely than female OB/GYNs (OR 2.1, CI 1.2 to 3.8) to hold this belief. Both male OB/GYNs (OR 1.9, CI 1.1 to 3.4) and rural practitioners (OR 2.1, CI 1.1 to 4.0) were more likely to believe that it was hard to withhold antibiotics for URI symptoms because other physicians prescribe antibiotics for these symptoms. OB/GYNs who believed that postgraduate training prepared them well for primary care management were more likely than those who did not (OR 2.1, CI 1.1 to 4.2) to believe that they could reduce antibiotic prescribing without reducing patient satisfaction.Conclusion:Multiple demographic factors affect attitudes and reported practices regarding antibiotic prescribing. However, in view of the low proportion of office visits for URIs, an OB/GYN-specific program is not warranted.

scholarly journals Antibiotic prescribing for acute, non-complicated infections in primary care in Germany: baseline assessment in the cluster randomized trial ARena

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Regina Poss-Doering ◽  
Dorothea Kronsteiner ◽  
Martina Kamradt ◽  
Edith Andres ◽  
Petra Kaufmann-Kolle ◽  
...  
Keyword(s):  
Primary Care ◽  
Antimicrobial Resistance ◽  
Respiratory Tract ◽  
General Practitioners ◽  
Respiratory Tract Infections ◽  
Reference Group ◽  
Antibiotic Prescribing ◽  
Tract Infections ◽  
Rational Use Of Antibiotics ◽  
To Receive

Abstract Background Antimicrobial resistance is fueled by inappropriate use of antibiotics. Global and national strategies support rational use of antibiotics to retain treatment options and reduce resistance. In Germany, the ARena project (Sustainable reduction of antibiotic-induced antimicrobial resistance) intended to promote rational use of antibiotics for acute non-complicated infections by addressing network-affiliated physicians, primary care teams and patients through multiple interacting interventions. The present study documented patterns of antibiotic prescribing for patients with acute non-complicated infections who consulted a physician in these networks at the start of the ARena project. It explored variation across subgroups of patients and draws comparisons to prescribing patterns of non-targeted physicians. Methods This retrospective cross-sectional analysis used mixed logistic regression models to explore factors associated with the primary outcome, which was the percentage of patient cases with acute non-complicated respiratory tract infections consulting primary care practices who were treated with antibiotics. Secondary outcomes concerned the prescribing of different types of antibiotics. Descriptive methods were used to summarize the data referring to targeted physicians in primary care networks, non-targeted physicians (reference group), and patient subgroups. Results Overall, antibiotic prescribing rates were 32.0% in primary care networks and 31.7% in the reference group. General practitioners prescribed antibiotics more frequently than other medical specialist groups (otolaryngologists vs. General practitioners OR = 0.465 CI = [0.302; 0.719], p < 0.001, pediatricians vs. General practitioners: OR = 0.369 CI = [0.135; 1.011], p = 0.053). Quinolone prescribing rates were 9.9% in primary care networks and 8.1% in reference group. Patients with comorbidities had a higher likelihood of receiving an antibiotic and quinolone prescription and were less likely to receive a guideline-recommended substance. Younger patients were less likely to receive antibiotics (OR = 0.771 CI = [0.636; 0.933], p = 0.008). Female gender was more likely to receive an antibiotic prescription (OR = 1.293 CI = [1.201, 1.392], p < 0.001). Conclusion This study provided an overview of observed antibiotic prescribing for acute non-complicated respiratory tract infections in German primary care at the start of the ARena project. Findings indicate potential for improvement and will serve as comparator for the post-interventional outcome evaluation to facilitate describing of potential changes.

scholarly journals A pragmatic randomized trial of a primary care antimicrobial stewardship intervention in Ontario, Canada

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Warren McIsaac ◽  
Sahana Kukan ◽  
Ella Huszti ◽  
Leah Szadkowski ◽  
Braden O’Neill ◽  
...  
Keyword(s):  
Primary Care ◽  
Antimicrobial Stewardship ◽  
Care Provider ◽  
Primary Care Provider ◽  
Antibiotic Use ◽  
Primary Care Providers ◽  
Audit And Feedback ◽  
Antibiotic Prescribing ◽  
Care Providers ◽  
Tract Infections

Abstract Background More than 90% of antibiotics are prescribed in primary care, but 50% may be unnecessary. Reducing unnecessary antibiotic overuse is needed to limit antimicrobial resistance. We conducted a pragmatic trial of a primary care provider-focused antimicrobial stewardship intervention to reduce antibiotic prescriptions in primary care. Methods Primary care practitioners from six primary care clinics in Toronto, Ontario were assigned to intervention or control groups to evaluate the effectiveness of a multi-faceted intervention for reducing antibiotic prescriptions to adults with respiratory and urinary tract infections. The intervention included provider education, clinical decision aids, and audit and feedback of antibiotic prescribing. The primary outcome was total antibiotic prescriptions for these infections. Secondary outcomes were delayed prescriptions, prescriptions longer than 7 days, recommended antibiotic use, and outcomes for individual infections. Generalized estimating equations were used to estimate treatment effects, adjusting for clustering by clinic and baseline differences. Results There were 1682 encounters involving 54 primary care providers from January until May 31, 2019. In intervention clinics, the odds of any antibiotic prescription was reduced 22% (adjusted Odds Ratio (OR) = 0.78; 95% Confidence Interval (CI) = 0.64.0.96). The odds that a delay in filling a prescription was recommended was increased (adjusted OR=2.29; 95% CI=1.37, 3.83), while prescription durations greater than 7 days were reduced (adjusted OR=0.24; 95% CI=0.13, 0.43). Recommended antibiotic use was similar in control (85.4%) and intervention clinics (91.8%, p=0.37). Conclusions A community-based, primary care provider-focused antimicrobial stewardship intervention was associated with a reduced likelihood of antibiotic prescriptions for respiratory and urinary infections, an increase in delayed prescriptions, and reduced prescription durations. Trial registration clinicaltrials.gov (NCT03517215).

Stewardship in the primary care and long-term care settings

2016 ◽  
Author(s):  
Naomi Fleming
Keyword(s):  
Primary Care ◽  
Antimicrobial Stewardship ◽  
Long Term Care ◽  
Diagnostic Tools ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Term Care ◽  
Care Facilities ◽  
Tract Infections

This chapter focuses on stewardship in the primary care and long-term care settings. Antibiotic prescribing in the community accounts for 80% total antibiotic prescribing and approximately 75% of this is for acute respiratory tract infections, many of which are viral. There is also significant variation in prescribing practices that is not explained by differences in presenting patients. These factors suggest that antimicrobial stewardship programmes are necessary. This chapter identifies the components of stewardship that have been successful in influencing antibiotic prescribing in primary care and shares local experiences with practical examples. The lack of UK evidence about antimicrobial stewardship in long-term care facilities is discussed, along with successful interventions from overseas. Challenges within these settings are highlighted, including patient demand, lack of access to microbiological and diagnostic tools, competing targets, time pressures, and clinical uncertainty.

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