COVID-19 and Antibiotic Prescribing in Pediatric Primary Care

BACKGROUND AND OBJECTIVES: With the onset of the coronavirus disease 2019 (COVID-19) pandemic, pediatric ambulatory encounter volume and antibiotic prescribing both decreased; however, the durability of these reductions in pediatric primary care in the United States has not been assessed. METHODS: We conducted a retrospective observational study to assess the impact of the COVID-19 pandemic and associated public health measures on antibiotic prescribing in 27 pediatric primary care practices. Encounters from January 1, 2018, through June 30, 2021, were included. The primary outcome was monthly antibiotic prescriptions per 1000 patients. Interrupted time series analysis was performed. RESULTS: There were 69 327 total antibiotic prescriptions from April through December in 2019 and 18 935 antibiotic prescriptions during the same months in 2020, a 72.7% reduction. The reduction in prescriptions at visits for respiratory tract infection (RTI) accounted for 87.3% of this decrease. Using interrupted time series analysis, overall antibiotic prescriptions decreased from 31.6 to 6.4 prescriptions per 1000 patients in April 2020 (difference of −25.2 prescriptions per 1000 patients; 95% CI: −32.9 to −17.5). This was followed by a nonsignificant monthly increase in antibiotic prescriptions, with prescribing beginning to rebound from April to June 2021. Encounter volume also immediately decreased, and while overall encounter volume quickly started to recover, RTI encounter volume returned more slowly. CONCLUSIONS: Reductions in antibiotic prescribing in pediatric primary care during the COVID-19 pandemic were sustained, only beginning to rise in 2021, primarily driven by reductions in RTI encounters. Reductions in viral RTI transmission likely played a substantial role in reduced RTI visits and antibiotic prescriptions.

Inequities in Chlamydia trachomatis Screening Between Black and White Adolescents in a Large Pediatric Primary Care Network, 2015–2019

Objectives. To identify associations between patient race and annual chlamydia screening among adolescent females. Methods. We performed a retrospective cohort study of females aged 15 to 19 years in a 31-clinic pediatric primary care network in Pennsylvania and New Jersey from 2015 through 2019. Using mixed-effect logistic regressions, we estimated associations between annual chlamydia screening and patient (race/ethnicity, age, previous chlamydia screening and infection, insurance type) and clinic (size, setting) characteristics. We decomposed potential effects of clinician’s implicit racial bias and screening, using covariates measuring the proportion of Black patients in each clinician’s practice. Results. There were 68 935 well visits among 37 817 females, who were 28.8% Black and 25.8% Medicaid insured. The mean annual chlamydia screening rate was 11.1%. Black females had higher odds of screening (adjusted odds ratio [AOR] = 1.67; 95% confidence interval [CI] = 1.51, 1.84) than did White females. In the clinician characteristics model, individual clinicians were more likely to screen their Black versus non-Black patients (AOR = 1.88; 95% CI = 1.65, 2.15). Conclusions. Racial bias may affect screening practices and should be addressed in future interventions, given the critical need to increase population-level chlamydia screening.(Am J Public Health. 2022;112(1):135–143. https://doi.org/10.2105/AJPH.2021.306498 )

Role of Occupational Therapy in Pediatric Primary Care: Promoting Childhood Development

Occupational therapy practitioners have the opportunity to promote development for all children as new service delivery models are established for pediatric primary care. Three action steps are identified: (1) advocacy for legislation that requires developmental screenings and surveillance, (2) support of culturally responsive developmental monitoring, and (3) building evidence for occupational therapy in primary care settings. This article describes the role of occupational therapy practitioners on pediatric interprofessional teams in encouraging family capacity within the scope of health promotion and universal developmental monitoring.

678. Rapid Molecular SARS-CoV-2 Detection by Abbott ID NOW Is Reliable in Pediatric Patients

Background The COVID-19 Pandemic demonstrated the importance of rapid, accurate, point of care testing to control spread of the virus. The availability of this testing has been crucial to re-opening schools, keeping children safely in schools, and returning children to school quickly following illness. The Abbott ID Now molecular assay to detect SARS-CoV-2 was granted Emergency Use Authorization in March 2020. Reports of lower sensitivity compared with conventional PCR prompted some school districts to require confirmatory conventional PCR for negative rapid molecular results to return children to school. In this study we aim to determine the sensitivity and specificity of the Abbott ID NOW molecular SARS-CoV-2 test in a large pediatric primary care practice. Methods A retrospective observational study was performed using data from 25 pediatric primary care sites in the Boston Children’s Health Physicians network, a large multispecialty pediatric practice in New York and Connecticut. Data were extracted from the electronic health record for all patients 0-22 years of age who had an Abbott ID NOW rapid molecular COVID-19 assay from October 1, 2020 - February 28, 2021. For all patients with rapid tests, we identified patients who had a conventional PCR test sent within 1 day before or 1 day after the ID NOW test. The result of the conventional PCR test was considered the “true” result. All discrepant test results were identified. Results During the study period, 14993 patients had ID NOW testing performed. The percent positivity was 8.5%. The percent positivity in our practices paralleled that in the surrounding community throughout the winter surge of COVID-19. 500 patients had confirmatory testing sent within 1 day before or after the ID NOW test (15 positive and 485 negative results). Based on the conventional PCR test results, 2 of 15 positive results were false positive and only 1 of 485 negative results was a false negative, resulting in a sensitivity of 93% and specificity of 99.6%. The false negative result was in a patient with nasal congestion whose mother was COVID positive. Conclusion Rapid, molecular, point of care testing is an important tool to identify SARS-CoV-2 in pediatric patients and limit school absences. The ID NOW assay is highly sensitive and specific in a real-world pediatric setting. Disclosures All Authors: No reported disclosures

162. The Impact of the COVID-19 Pandemic on Antibiotic Prescribing in Pediatric Primary Care

Background With the onset of the coronavirus disease 2019 (COVID-19) pandemic, pediatric primary care delivery changed rapidly. Prior studies have demonstrated a reduction in ambulatory encounters and antibiotic prescriptions with the pandemic onset; however, the durability of these reductions in pediatric primary care in the United States has not been assessed. Methods We conducted a retrospective cohort study to assess the impact of the COVID-19 pandemic and associated public health measures (e.g. social distancing, masking, school closures, and increased availability of telemedicine) on antibiotic prescribing and encounter volume in 27 pediatric primary care practices, and the duration of these changes. Patients under age 19 with an encounter from January 1, 2018 through December 31, 2020 were included. The primary outcome was monthly antibiotic prescriptions per 1000 patients, in the overall population and a subset of encounters with infectious diagnoses, including respiratory tract infections (RTIs). Interrupted time series (ITS) analysis was performed. Results There were 60,562 total antibiotic prescriptions from April to December in 2019 and 14,605 antibiotic prescriptions during the same months in 2020, a 76% reduction. The reduction in RTI encounter prescriptions accounted for 91.5% of the overall reduction in prescriptions from 2019 to 2020. Using ITS analysis, there was an immediate decrease from 31.6 to 7.4 prescriptions/1000 patients (predicted means) in April 2020 (-24.2 prescriptions/1000 patients; 95% CI: -31.9, -16.4) (Figures 1 and 2). This was followed by a stable rate of antibiotic prescriptions that remained flat through December 2020. For RTI encounters, a similar pattern was seen, with a decrease by 21.8 prescriptions/1000 patients; 95% CI: -29.5, -14.2) (Figures 1 and 2). Encounter volume also decreased immediately, and while overall encounter volume began returning to a pre-pandemic baseline volume toward the end of the study period, RTI encounter volume remained persistently lower through December 2020 (Figure 3). Figure 1. Antibiotic prescriptions per 1000 patients prescribed by month from January 2018 to December 2020, overall and for disease-specific subgroups RTI = respiratory tract infection; UTI = urinary tract infection; SSTI = skin and soft tissue infection. Months are numbered sequentially, starting with January (number 1). Dashed line indicates first full month of the pandemic, April 2020. Interrupted time series analysis for antibiotic prescriptions per 1000 patients by month from January 2018 to December 2020 for (A) all antibiotics as well as antibiotics prescribed at encounters with (B) respiratory tract infections (RTIs), (C) urinary tract infections (UTIs), and (D) skin and soft tissue infections (SSTIs) Intervention starts in April 2020 (dashed line). Months are numbered sequentially, starting with January (number 1). Dashed line indicates first full month of the pandemic, April 2020. Antibiotic prescriptions per 1000 billed encounters by month from January 2018 to December 2020 for (A) all encounters, as well as antibiotics prescribed at encounters with (B) respiratory tract infections (RTIs), (C) urinary tract infections (UTIs), and (D) skin and soft tissue infections (SSTIs) Months are numbered sequentially, starting with January (number 1). Conclusion Dramatic reductions in antibiotic prescribing in pediatric primary care during the COVID-19 pandemic were sustained through 2020, primarily driven by reductions in RTI encounters. Disclosures All Authors: No reported disclosures

Implications of the COVID-19 Pandemic for Pediatric Primary Care Practice in Europe

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