Objective: To identify the proportion of viral acute upper respiratory tract infections (AURTI) inappropriately treated with antibiotics before and after the implementation of a multimodal outpatient antibiotic stewardship initiative in a real-world setting.Design: Pre-post, quasi-experimental study. Patients: Adult patients with a diagnosis of either acute bronchitis, influenza, unspecified viral infection, or unspecified AURTI who visited internal medicine (IM) or family medicine (FM) ambulatory care clinics at an urban, academic health system in 2016 and 2017. Interventions: Provider education including the dissemination of an institutional guideline and algorithm for the treatment of AURTI occurred in FM and IM clinics. In the FM clinics, a roundtable discussion with clinicians promoting safe and appropriate antibiotic prescribing was conducted, and patient-facing educational posters were placed in exam rooms and clinic waiting areas describing the FM teams' commitment to using antibiotics only when necessary. Results: A total of 2817 patient encounters met study inclusion criteria. In total, inappropriate antibiotic prescribing had a relative decrease of 24% after implementation of the interventions (17.2% [235/1362] preintervention vs 13.1% [191/1455] postintervention; P = .02). During the preintervention period, 25.4% (143/563) of the encounters in the IM clinics were associated with inappropriate antibiotic prescribing compared with 19% (108/568) in the postintervention period (P < .01). Relative to the IM clinics, the FM clinics had a lower proportion of encounters associated withinappropriate antibiotic prescribing at baseline. In FM clinics, 11.5% (92/799) of encounters were associated with inappropriate antibiotic prescribing during the preintervention period compared with 9.4% (83/887) during the postintervention period (P = .15).
BackgroundAcute upper respiratory tract infections (URI) result in significant outpatient antimicrobial prescriptions and are targets for antimicrobial stewardship efforts given they are often of viral origin. Our objective was to evaluate the impact of educational antimicrobial stewardship initiatives on the proportion of URI treated with antibiotics in a large, ambulatory setting that included Internal Medicine and Family Medicine clinics.MethodsThis quasi-experimental pre–post intervention study evaluated antibiotic prescribing for URI from January 1, 2016 to December 31, 2017. The calendar year 2016 was considered the preintervention time period. The stewardship interventions were implemented in December 2016 and included practitioner education on URI treatment guidelines (education) and commitment to safe antibiotic use posters displayed in patient rooms and clinic waiting areas (poster). Education was provided in both clinics whereas posters were displayed only in the family medicine clinic. ICD-10 codes were used to identify cases, excluding patients with COPD. The primary endpoint was the proportion of patient visits for URI where antibiotics were prescribed for the treatment of acute bronchitis, influenza, and unspecified viral infection collectively.ResultsThere were 1,533 encounters preintervention and 1,479 postintervention. In the internal medicine clinic (education only), the rate of antibiotics prescribed for all URI diagnoses preintervention was 24.5% vs. 19.0% post (P = 0.022). In the family medicine clinic (education + poster), the antibiotic prescribing rate for all URI diagnoses preintervention was 11.0% vs. 9.4% post (P = 0.242). The overall rate of antibiotics prescribed for all clinics was 16.6% preintervention vs. 13.0% postintervention (P = 0.009).ConclusionThe educational and antimicrobial stewardship initiatives implemented in these outpatient clinics may have contributed to a significantly reduced rate of inappropriately prescribed antibiotics for URI in the internal medicine clinic and both clinics overall. The addition of the poster was not associated with a significant change in practice. However, these results demonstrate the potential utility of the educational initiative, and that stewardship strategies may have a different impact by clinic setting.Disclosures All authors: No reported disclosures.
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