Purpose An estimated 30% of all outpatient antibiotic prescriptions in the United States are unnecessary. The Joint Commission in 2016 implemented core elements of performance requiring antimicrobial stewardship programs (ASPs) to expand to outpatient practice settings. A study was conducted to determine whether pharmacist-led audit and feedback would improve antibiotic prescribing for urinary tract infections (UTIs) and skin and soft tissue infection (SSTIs) at 2 primary care practices. Methods A retrospective, quasi-experimental study was conducted to evaluate antibiotic prescribing for patients treated for a UTI or SSTI at 2 primary care offices (a family medicine office and an internal medicine office). The primary objective was to compare the rate of appropriate antibiotic prescribing to patients treated before implementation of a pharmacist-led audit-and-feedback process for reviewing antibiotics prescribed for UTIs and SSTIs (the pre-ASP group) and patients treated after process implementation (the post-ASP group). Total regimen appropriateness was defined by appropriate antibiotic selection, dose, duration, and therapy indication in accordance with institutional outpatient empiric therapy guidelines. Secondary objectives included comparing rates of infection-related revisits and Clostridioides difficile infection between groups. Results A total of 400 patients were included in the study (pre-ASP gropu, n = 200; post-ASP group, n = 200). The rate of total antibiotic prescribing appropriateness improved significantly, from 27.5% to 50.5% (P < 0.0001), after implementation of the audit-and-feedback process. There were also significant improvements in the post-ASP group vs the pre-ASP period in the individual components of regimen appropriateness: appropriate drug (70% vs 53%, P < 0.001), appropriate duration (83.5% vs 57.5% , P < 0.001), and appropriate therapy indication (98% vs 94% , P = 0.041). There were no significant between-group differences in other outcomes such as rates of adverse events, treatment failure, C. difficile infection, and infection-related revisits or hospitalizations within 30 days. Conclusion A pharmacist-led audit-and-feedback outpatient stewardship strategy was demonstrated to achieve significant improvement in outpatient antibiotic prescribing for UTI and SSTI.
Introduction Streptococcus pneumoniae is a leading cause of bacterial infections and leads to 1.5 million hospitalizations annually. Vaccinations are one of the most important and cost‐effective tools available in healthcare to prevent infectious diseases. However, gaps still exist between what is recommended and actual vaccination rates in the United States. Objective The primary objective of this study was to assess the impact of a newly implemented pharmacist‐led pneumococcal vaccination outreach program on overall PPSV23 rates in the primary care setting. Methods This was a retrospective, quasi‐experimental study conducted following the implementation of a newly developed, pharmacist‐led, vaccination outreach program as part of a novel standard of care practice implemented in two primary care offices. Pharmacists provided direct patient outreach through telephone calls to all patients deemed eligible for PPSV23 that met inclusion criteria. Pharmacists provided counseling on PPSV23 and action steps to receive the vaccine at the office through appointment. The primary outcome of change in vaccination rates was assessed 90 days after patient outreach. Secondary outcomes assessed feasibility, common barriers to vaccination, coadministration with influenza vaccination, and revenue changes. Results A total of 762 patients were contacted under the outreach program. Overall PPSV23 vaccination rates significantly increased following the implementation of the pharmacist‐led vaccination outreach program (54.1% vs 60.5%, P < 0.001). Of the 398 patients reached, 38.9% accepted the recommendation for PPSV23 and 66.5% of those patients had confirmed administration. Approximate revenue generation secondary to the program was $5568.85. Conclusion A pharmacist‐led PPSV23 vaccination outreach program significantly increased the rate of PPSV23 vaccination in two primary care offices, leading to improved compliance with national vaccination recommendations and revenue generation.
Platinum electrodes were chemically modified with tris(5-amino-1,10-phenanthroline) ruthenium(II) via electropolymerization. The characterization of the thin films was accomplished with cyclic voltammetry (CV) and Rutherford Backscattering Spectrometry (RBS). Data indicates a strong correlation between the peak currents from the characterization cyclic voltammograms and the number of cycles of electropoly-merization. Rutherford Backscattering Spectrometry showed the same trend, and verified that film thickness is strongly dependent on the concentration of the monomer ruthenium solution. Film thickness was determined from the change in ion beam energy as it passed through the film and was calculated to be 1.0 x 10 18 atoms/cm 2 -3.4 x 10 18 atoms/cm 2 , depending upon the number of electropolymerization cycles. The electrodes also showed differences in surface roughness, which were dependent on film thickness.
Introduction Due to the high volume of outpatient antibiotic prescribing, the Joint Commission now requires antimicrobial stewardship program (ASP) expansion to ambulatory practice settings. Unfortunately, ASP resources in these settings are scarce. The purpose of this study was to determine whether the implementation of antibiotic order sentences alongside education would improve antibiotic prescribing for urinary tract infections (UTI) and skin and soft tissue infections (SSTI). Objectives The primary objective was to compare the proportion of total guideline‐concordant antibiotic prescribing before (pre‐ASP) vs after (post‐ASP) implementing order sentences. Guideline concordance was defined as antibiotic selection, dosing, and duration in accordance with the health system's empiric guidelines. Secondary objectives included comparing patient‐centered outcomes, such as infection‐related revisits and Clostridiodes difficile infections between groups. Methods This retrospective, quasi‐experimental study evaluated adult patients treated for uncomplicated UTI or SSTI at an outpatient Family Medicine office between 1 February 2020 and 1 January 2021. The institution's stewardship team provided in‐person education and set prescribing order sentence “favorites” for providers. Patients were excluded who were diagnosed with a complicated UTI, treated only with topical antibiotics, were pregnant, or received care via telephone encounter. Results Two hundred sixty patients were included in this study (pre‐ASP n = 139, post‐ASP n = 121). Total antibiotic appropriateness improved significantly from 24.5% to 39.7% after implementation of order sentences and education (P = .008). Significant improvement was seen for appropriate drug selection (52.5% vs 66.9%, P = .018) and duration (47.5% vs 68.6%, P = .001). There were no differences observed in patient‐centered outcomes between groups. Conclusion Implementing stewardship‐focused order sentences significantly improved outpatient antibiotic prescribing for UTI and SSTI. Tailoring antibiotic order sentences may be a useful tool for ASP expansion into the outpatient setting with limited resources to allocate to stewardship efforts.
Background An estimated 30% of all outpatient antibiotic prescriptions in the U.S. are unnecessary. Effective January 2020, The Joint Commission has implemented new core elements of performance requiring antimicrobial stewardship programs (ASP) to expand to outpatient practice settings. The purpose of this study was to determine whether pharmacist-led audit-and-feedback would improve antibiotic prescribing for urinary tract infections (UTI) and skin and soft tissue infection (SSTI) at two primary care practices. Methods This retrospective, quasi-experimental study was conducted evaluating patients treated for UTI and SSTI at two outpatient primary care offices, one Family Medicine and the other Internal Medicine. The primary objective was to compare rates of total appropriateness of antibiotic prescribing before (Pre-ASP) versus after (Post-ASP) implementing a pharmacist-led audit-and-feedback process reviewing antibiotics prescribed for UTIs and SSTIs. Total appropriateness was defined by appropriate antibiotic selection, dose, duration, and therapy indication in accordance with institutional outpatient empiric therapy antimicrobial guidelines. Secondary objectives included comparing patient outcomes, including infection-related re-visits and Clostridioides difficile infections between groups. Results A total of 400 patients were included in this study (Pre-ASP n=200, Post-ASP n=200) Total antibiotic appropriateness improved significantly from 27.5% to 50.5% after implementation of the audit-and-feedback process (p< 0.0001). Significant improvement was also seen for individual prescribing components including appropriate drug selection (94% vs. 98%, p=0.041), duration (57.5% vs.83.5%, p< 0.0001), and therapy indication (94% vs. 98%, p=0.041). There were no differences in patient outcomes between groups including adverse drug events, treatment failure, C.difficile infections, and infection-related re-visits or hospitalizations within 30 days. Conclusion A pharmacist-led audit-and-feedback outpatient stewardship strategy demonstrated significant improvement in outpatient antibiotic prescribing for UTI and SSTI. Disclosures All Authors: No reported disclosures
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