A Multisite Collaborative to Decrease Inappropriate Antibiotics in Urgent Care Centers

Abstract

BACKGROUND: Urgent care (UC; a convenient site to receive care for ambulatory-sensitive) centers conditions; however, UC clinicians showed the highest rate of inappropriate antibiotic prescriptions among outpatient settings according to national billing data. Antibiotic prescribing practices in pediatric-specific UC centers were not known but assumed to require improvement. The aim of this multisite quality improvement project was to reduce inappropriate antibiotic prescribing practices for 3 target diagnoses in pediatric UC centers by a relative 20% by December 1, 2019. METHODS: The Society of Pediatric Urgent Care invited pediatric UC clinicians to participate in a multisite quality improvement study from June 2019 to December 2019. The diagnoses included acute otitis media (AOM), otitis media with effusion, and pharyngitis. Algorithms based on published guidelines were used to identify inappropriate antibiotic prescriptions according to indication, agent, and duration. Sites completed multiple intervention cycles from a menu of publicly available antibiotic stewardship materials. Participants submitted data electronically. The outcome measure was the percentage of inappropriate antibiotic prescriptions for the target diagnoses. Process measures were use of delayed antibiotics for AOM and inappropriate testing in pharyngitis. RESULTS: From 20 UC centers, 157 providers submitted data from 3833 encounters during the intervention cycles. Overall inappropriate antibiotic prescription rates decreased by a relative 53.9%. Inappropriate antibiotic prescribing decreased from 57.0% to 36.6% for AOM, 54.6% to 48.4% for otitis media with effusion, and 66.9% to 11.7% for pharyngitis. CONCLUSIONS: Participating pediatric UC providers decreased inappropriate antibiotic prescriptions from 60.3% to 27.8% using publicly available interventions.

Communication Strategies to Improve Antibiotic Prescribing in Pediatric Urgent Care Centers

“…Delayed prescribing for AOM has been shown to reduce antibiotic use by as much as 56% 18 ; however, increasing delayed prescribing for AOM has not been successful in similar cohorts of pediatric UC providers. 3 In contrast, delayed prescribing for eligible encounters with a diagnosis of AOM trended upward after our third PDSA 3, where participants engaged in communication strategies specific to discussing delayed prescribing with families. Our intervention specifically addressed the barrier reported by clinicians.…”

“…To determine antibiotic appropriateness for each encounter, the leadership team used previously developed algorithms based on the 2004 American Academy of Otolaryngology -Head and Neck Surgery and American Academy of Pediatrics joint guidelines for OME, the 2013 American Academy of Pediatrics guidelines for AOM, and the 2012 Infectious Diseases Society of America (IDSA) guidelines for group A streptococcal (GAS) pharyngitis. 3,[10][11][12] We used a 3-tiered classification system from previously published literature to determine if antibiotics were appropriate for encounters taking into consideration any associated codiagnoses. 3,[13][14][15] Encounters prescribed antibiotics with codiagnoses for which antibiotics might be indicated were considered appropriate.…”

“…3,[10][11][12] We used a 3-tiered classification system from previously published literature to determine if antibiotics were appropriate for encounters taking into consideration any associated codiagnoses. 3,[13][14][15] Encounters prescribed antibiotics with codiagnoses for which antibiotics might be indicated were considered appropriate. We also measured the individual rate of inappropriate antibiotics for OME, AOM, and pharyngitis.…”

Antibiotic Prescribing Patterns for Pediatric Urgent Care Clinicians

“…We recruited pediatric UC clinicians from across the United States via the Society of Pediatric Urgent Care listserv, newsletters, and national webinars to participate in this observational study, which was used to identify target diagnoses for a multicenter quality improvement project 9 . Participants submitted patient demographics, diagnoses, and antibiotic information for 10 consecutive patient encounters when they prescribed antibiotics and submitted the data electronically via Research Electronic Data Capture (REDCap) 10,11 . Participants collected data during 2 time periods: March 21, 2019–April 6, 2019, and May 5, 2019–May 11, 2019.…”

“…9 Participants submitted patient demographics, diagnoses, and antibiotic information for 10 consecutive patient encounters when they prescribed antibiotics and submitted the data electronically via Research Electronic Data Capture (REDCap). 10,11 Participants collected data during 2 time periods: March 21, 2019-April 6, 2019, and May 5, 2019-May 11, 2019. Encounters in which only topical antibiotics were prescribed were excluded.…”