Community pharmacist–physician collaborative streptococcal pharyngitis management program

Klepser, Donald G.; Klepser, Michael E.; Dering-Anderson, Allison M.; Morse, Jacqueline; Smith, Jaclyn K.; Klepser, Stephanie A.

doi:10.1016/j.japh.2015.11.013

Cited by 61 publications

(75 citation statements)

References 24 publications

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“…The published studies on influenza are consistent with the success pharmacists have demonstrated in judiciously managing antimicrobials for patients with Group A Streptococcal pharyngitis and urinary tract infections …”

Section: Key Areas Of Concern From Stakeholderssupporting

confidence: 63%

Pharmacy-based management of influenza: lessons learned from research

Klepser

Adams

2018

International Journal of Pharmacy Practice

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Recently, several jurisdictions have pursued legislative and regulatory changes to allow pharmacy‐based influenza management models in which pharmacists can initiate appropriate antiviral therapy in community pharmacy settings. While studies have been published in Canada, Japan, New Zealand, Norway and the United States, concerns have been expressed over pharmacist training, the accuracy of rapid influenza diagnostic tests, and the potential impact on antimicrobial resistance, among others. Studies have demonstrated that pharmacists provide safe and effective influenza management, with high rates of patient satisfaction, while maintaining or improving antimicrobial stewardship.

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Section: Key Areas Of Concern From Stakeholderssupporting

confidence: 63%

Pharmacy-based management of influenza: lessons learned from research

Klepser

Adams

2018

International Journal of Pharmacy Practice

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“…Other antimicrobial stewardship efforts seen in the ambulatory care setting have demonstrated improvements in antibiotic prescribing, though they have not been pharmacist driven 11,16‐20 . One study looked at the effects of a letter posted in patient rooms emphasizing clinician commitment to guideline appropriate antibiotic prescribing compared to a control group 12 .…”

Section: Discussionmentioning

confidence: 99%

Impact of ambulatory antimicrobial stewardship on prescribing patterns for urinary tract infections

et al. 2020

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What is known and Objective Currently, there are limited data on ambulatory antimicrobial stewardship (AAMS) programmes in the primary care setting. The purpose of this study was to implement a pharmacist‐led AAMS programme for uncomplicated cystitis (UC) and pyelonephritis in a hospital‐based family medicine residency clinic. Methods A retrospective cohort study was used to assess clinician prescribing habits and identify areas of inappropriate prescribing. Females between 18 and 64 years old diagnosed with UC or pyelonephritis were included in the analysis. The primary objective was a composite of appropriate choice of antibiotic based on first‐line recommendations, appropriate dose and appropriate duration of therapy. The intervention included development of a guideline‐based antibiotic treatment summary accessible in the electronic health record (EHR), clinician education sessions for medical residents and faculty, and treatment defaults in the EHR. Results and Discussion Eighty‐one patients were included in the pre‐intervention group and 81 in the post‐intervention group. In the pre‐intervention group, 37% of patients met the composite primary outcome vs. 71.6% in the post‐intervention group (P < .001) for UC and pyelonephritis combined. This was primarily driven by improvement in appropriate duration of therapy for both diagnoses which increased from 44.4% to 84.0% (P < .001). What is new and Conclusions A pharmacist‐led AAMS programme significantly improved guideline‐based treatment adherence for UC and pyelonephritis based on the composite of appropriate choice of antibiotic, appropriate dose and appropriate duration of therapy in a primary care family medicine setting.

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“…Point of care diagnostics are available for respiratory tract infections including Group A Streptococcus and influenza [22]. There is some evidence supporting point of care testing to reduce antibiotic prescribing for respiratory tract infections [23,40].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with antibiotic prescribing for acute bronchitis at a university health center

et al. 2020

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Background: Antibiotics are not indicated for treating acute bronchitis cases, yet up to 70% of adult acute bronchitis medical visits in the USA result in an antibiotic prescription. Reducing unnecessary antibiotic prescribing for acute bronchitis is a key antibiotic stewardship goal set forth by the Centers for Disease Control and Prevention. Understanding what factors influence prescribing for bronchitis cases can inform antimicrobial stewardship initiatives. The goal of this study was to identify factors associated with antibiotic prescribing at a high-volume student health center at a large US university. The Pennsylvania State University Health Services offers on-campus medical care to a population of over 40,000 students and receives over 50,000 visits every year. Methods: We conducted a retrospective chart review of acute bronchitis visits for the 2015-2016 academic year and used a multivariate logistic regression analysis to identify variables associated with antibiotic prescribing. Results: Findings during lung exams increased the likelihood of an antibiotic prescription (rales OR 13.95, 95% CI 3.31-80.73; rhonchi OR 5.50, 95% CI 3.08-10.00; percussion abnormality OR 13.02, 95% CI 4.00-50.09). Individual clinicians had dramatically different rates of prescribing (OR range 0.03-12.3). Male patients were more likely than female patients to be prescribed antibiotics (OR 1.68, 95% CI 1.17-2.41). Patients who reported longer duration since the onset of symptoms were slightly more likely to receive prescriptions (OR 1.04 per day, 95% CI 1.03-1.06), as were patients who reported worsening symptoms (OR 1.78, 95% CI 1.03-3.10). Visits with diagnoses or symptoms associated with viral infections or allergies were less likely to result in prescriptions (upper respiratory tract infection (URI) diagnosis OR 0.33, 95% CI 0.18-0.58; sneezing OR 0.39, 95% CI 0.17-0.86; vomiting OR 0.31, 95% CI 0.10-0.83). An exam finding of anterior cervical lymphadenopathy was associated with antibiotic prescribing (tender OR 3.85, 95% CI 1.70-8.83; general OR 2.63, 95% CI 1.25-5.54). Conclusions: Suspicious findings during lung examinations (rales, rhonchi, percussion abnormality) and individual healthcare providers were important factors influencing antibiotic prescribing rates for acute bronchitis visits. Patient gender, worsening symptoms, duration of illness, symptoms associated with viral infections or allergies, and anterior cervical lymphadenopathy also influenced prescribing rates.

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Community pharmacist–physician collaborative streptococcal pharyngitis management program

Cited by 61 publications

References 24 publications

Pharmacy-based management of influenza: lessons learned from research

Pharmacy-based management of influenza: lessons learned from research

Impact of ambulatory antimicrobial stewardship on prescribing patterns for urinary tract infections

Factors associated with antibiotic prescribing for acute bronchitis at a university health center

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