BACKGROUND: Inappropriate use of antibiotics in the outpatient setting is a common problem, yet literature evaluating best practices for stewardship interventions in this setting is sparse. OBJECTIVE: To evaluate the impact of clinical decision support (CDS) order panels for azithromycin prescribing on the percentage of inappropriate azithromycin prescriptions in primary care clinics. DESIGN: Single-center, retrospective analysis of azithromycin prescribing within nine primary care clinics. Pre-intervention and post-intervention data included azithromycin prescriptions from November 2016 to April 2017 and February 2019 to July 2019, respectively. Key exclusion criteria included prescriptions for the treatment of a sexually transmitted infection or for prophylaxis against Mycobacterium avium complex. INTERVENTION: The azithromycin CDS panel was created to provide point-of-care information on appropriate use of azithromycin along with recommended alternatives based on indications. CDS panels were implemented on January 10, 2019. MAIN MEASURES: The primary composite outcome was the change in the percentage of inappropriate azithromycin prescribing before and after implementation of CDS panels. The composite outcome included prescriptions with inappropriate indications for azithromycin, unnecessary prescriptions, inappropriate treatment durations, and/or inappropriate dose. KEY RESULTS: There were 306 and 263 prescriptions for azithromycin prescriptions included for analysis in the pre-and post-intervention periods, respectively. Inappropriate prescriptions decreased by 12.6% from the pre-to post-intervention period (81.4% vs. 68.8%; P < 0.001). In both the pre-and post-intervention period, bronchitis and unspecified upper respiratory tract infections (URI) were the two most common indications where azithromycin was prescribed inappropriately. CONCLUSIONS: Implementation of CDS order panels resulted in a reduction in inappropriate azithromycin prescribing. However, additional improvement in azithromycin prescribing is needed especially for the indications of bronchitis and unspecified URI.
Background: Clinical pharmacists are uniquely positioned to assist with the complexities of medication management for patients with multiple sclerosis (MS). The objective of this study is to describe clinical pharmacy services provided as well as provider satisfaction and perceived impact of incorporating a clinical pharmacist in MS patient care. Methods: This study was conducted in two parts: a retrospective chart review and provider survey conducted in an outpatient neurology clinic at an academic medical center. Between April 2017 and June 2018, electronic medical records (EMRs) of patients with documented interventions by a pharmacist were reviewed to describe clinical pharmacy services provided to MS patients. A voluntary, anonymous survey was distributed to neurology providers to evaluate provider satisfaction and perceived impact of clinical pharmacist involvement in MS patient care. Results: There were 64 patients identified during the study period with 378 documented interventions made by clinical pharmacists. Pharmacist interventions were most commonly related to facilitating medication access (N=208), pre-treatment screening (N=57), patient counseling (N=51), and providing drug information (N=43). All providers surveyed (n=9) indicated that facilitating medication access, patient counseling, and drug interaction management were moderately or very important clinical pharmacy services. Furthermore, all providers surveyed strongly agreed that pharmacist involvement decreased time to therapy initiation for patients and decreased provider time spent on medication management. Conclusions: Clinical pharmacists play an integral role in MS patient care, particularly with facilitating medication access. Prospective studies are needed to further evaluate the contribution of clinical pharmacists in the care of MS patients.
scoring was working appropriately for all items of both domains. Reliability was good for activity limitations and modest for socio-emotional functioning (reliability coefficients of 0.89 and 0.78 respectively). Both domains showed only minor deviation to Rasch model in terms of item fit, local dependency, and invariance. The individual estimates of visual functioning from our RMT analysis were highly correlated to NEI VFQ-28R scores obtained with scoring algorithm from the original analysis (r.0.99), demonstrating stability of the results in this new sample. Conclusions: The RMT results in a sample of nAMD patients were similar to those obtained originally in the development of NEI VFQ-28R score in a more heterogeneous sample: two domains of NEI VFQ-28R have adequate psychometric performance for measuring visual functioning in nAMD overall, but may not allow showing improvement in already highly functioning patients.
Background: According to the CDC Core Elements of Outpatient Stewardship, the first step in optimizing outpatient antibiotic use the identification of high-priority conditions in which antibiotics are commonly used inappropriately. Azithromycin is a broad-spectrum antimicrobial commonly used inappropriately in clinical practice for nonspecific upper respiratory infections (URIs). In 2017, a medication use evaluation at Grady Health System (GHS) revealed that 81.4% of outpatient azithromycin prescriptions were inappropriate. In an attempt to optimize outpatient azithromycin prescribing at GHS, a tool was designed to direct the prescriber toward evidence-based therapy; it was implemented in the electronic medical record (EMR) in January 2019. Objective: We evaluated the effect of this tool on the rate of inappropriate azithromycin prescribing, with the goal of identifying where interventions to improve prescribing are most needed and to measure progress. Methods: This retrospective chart review of adult patients prescribed oral azithromycin was conducted in 9 primary care clinics at GHS between February 1, 2019, and April 30, 2019, to compare data with that already collected over a 6-month period in 2017 before implementation of the antibiotic prescribing guidance tool. The primary outcome of this study was the change in the rate of inappropriate azithromycin prescribing before and after guidance tool implementation. Appropriateness was based on GHS internal guidelines and national guidelines. Inappropriate prescriptions were classified as inappropriate indication, unnecessary prescription, excessive or insufficient treatment duration, and/or incorrect drug. Results: Of the 560 azithromycin prescriptions identified during the study period, 263 prescriptions were included in the analysis. Overall, 181 (68.8%) of azithromycin prescriptions were considered inappropriate, representing a 12.4% reduction in the primary composite outcome of inappropriate azithromycin prescriptions. Bronchitis and unspecified upper respiratory tract infections (URI) were the most common indications where azithromycin was considered inappropriate. Attending physicians prescribed more inappropriate azithromycin prescriptions (78.1%) than resident physicians (37.0%) or midlevel providers (37.0%). Also, 76% of azithromycin prescriptions from nonacademic clinics were considered inappropriate, compared with 46% from academic clinics. Conclusions: Implementation of a provider guidance tool in the EMR lead to a reduction in the percentage of inappropriate outpatient azithromycin prescriptions. Future targeted interventions and stewardship initiatives are needed to achieve the stewardship program’s goal of reducing inappropriate outpatient azithromycin prescriptions by 20% by 1 year after implementation.Funding: NoneDisclosures: None
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