Changes in antibiotic use following implementation of a telehealth stewardship pilot program

Wilson, Brigid; Banks, Richard; Crnich, Christopher; Ide, Emma; Viau, Roberto; Chakhtoura, Nadim G. El; Jones, Yvonne; Cherry, Jason; Anderson, Brett A; Jump, Robin L.P.

doi:10.1017/ice.2019.128

Cited by 18 publications

(15 citation statements)

References 13 publications

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“…1 Although only 2% to 10% of ARS is bacterial in origin, physicians frequently prescribe antibiotics over 50% of the time. [2][3][4][5] The judicious usage of antibiotics in ARS treatment plans is essential for mitigating antimicrobial resistance, limiting idiosyncratic adverse events related to antibiotics, and improving patient outcomes more broadly.…”

Section: Introductionmentioning

confidence: 99%

Antibiotic Prescribing for Acute Rhinosinusitis: In‐Person Versus Virtual Visits During Covid‐19

Miller

Bhattacharyya

2020

The Laryngoscope

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Objectives/Hypothesis: Determine if antibiotic prescribing patterns differ for in-person versus virtual clinic visits for acute rhinosinusitis (ARS).Study Design: Cross sectional study. Methods: All adult virtual clinical encounters from March to May 2020 with a principal diagnosis of ARS were reviewed for demographic data and the presence or absence of an antibiotic prescription during the coronavirus shut down in Massachusetts. In-person clinical encounters from March to May 2019 were similarly examined as a control. The rate of antibiotic prescription was compared between virtual (2020) and in-person ( 2019) visits for ARS diagnoses.Results: There were 2,075 patients in March to May 2020 and 3,654 patients March to May 2019 who received an ARS principal diagnosis at their virtual and in-person outpatient visits, respectively. There was a statistically significant lower rate of antibiotic prescriptions for ARS in 2020 (72.1%) versus 2019 (76.7%).The odds ratio for an antibiotic prescription for ARS was 0.783 (95% confidence interval, 0.693-0.86; P < .001) for patients seen in the 2020 cohort versus the 2019 cohort. The compared rates for antibiotic prescribing for 2020 versus 2019 were not different in individual month-to-month comparisons. When stratified by otolaryngology providers there was no statistically significant difference of antibiotic prescriptions between the 2019 and 2020 cohort (P = .781).Conclusions: During the massive transition to virtual visits for March to May 2020 due to the coronavirus pandemic shut down in Massachusetts, the total rate of outpatient antibiotic prescribing for ARS was lower in the virtual visit environment compared to the traditional in-person visit. In this scenario, telemedicine did not result in an increase in antibiotic prescribing despite the lack of an in-person physical exam.

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Section: Introductionmentioning

confidence: 99%

Antibiotic Prescribing for Acute Rhinosinusitis: In‐Person Versus Virtual Visits During Covid‐19

Miller

Bhattacharyya

2020

The Laryngoscope

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“…Intervention acceptance rates after 1 year of the pilot were 73% (186/256) and 65% (99/153) at sites A and B, respectively. Later, a 1‐year prospective quasi‐experimental study completed in parallel at these two sites published by Wilson et al demonstrated that this TASP led to significant ( P < .05) decreases in overall antimicrobial usage measured as days of therapy per 1000 days‐of‐care in the acute and long‐term care units at both sites 27 …”

Section: Integrated Tasp Modelsmentioning

confidence: 99%

Tele‐antimicrobial stewardship programs: A review of the literature and the role of the pharmacist

Andrzejewski¹,

McCreary

Khadem

et al. 2021

J Am Coll Clin Pharm

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Antimicrobial overuse and multidrug‐resistant pathogens are growing problems throughout the United States, yet most counties in the United States lack access to infectious diseases (ID) expertise. Developing an effective antimicrobial stewardship program (ASP) is challenging for many health care institutions, especially rural, community, and critical access hospitals with limited access to specialty care. Pharmacists are instrumental for the success of ASPs and pharmacy expertise is a requirement to meet federal ASP standards. Antimicrobial stewardship guidelines suggest telehealth consultation as an acceptable alternative to in‐person availability of an ID physician‐pharmacist team and encourage facilities to consider creative solutions for optimizing antimicrobial use. As a result, an understanding of successful telemedicine and tele‐ASP (TASP) models as a sustainable option is crucial. Data on existing TASP models, the role of clinical pharmacy services in TASPs, and future directions are herein described. Existing data on TASP are organized into three main categories of fully remote, integrated, or collaborative TASP models. TASPs may be led by remote ID physicians and/or ID‐trained clinical pharmacists within an affiliated health system or from an unaffiliated private practice, health system, or private telehealth entity. The on‐site stewardship pharmacist champion has a vital role in the success of many of the TASP models described by building trusting relationships with prescribers and key stakeholders, facilitating uptake of interventions and acceptance of the TASP, and ensuring timely therapy changes for patients. Future targets for TASP research should include TASP efforts in critical access hospitals and nonacute settings, the specific role of technology and clinical decision support software tools in TASP to improve and enhance pharmacist impact, and further descriptions of TASP models that improve patient‐centered outcomes.

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“…[26][27][28][29][30] All but 1 study involved a remote ID physician as a member of the IDt ASP. 19 The level of engagement of local caregivers in the IDt ASP can also vary; some programs identifying local ASP champions such as pharmacists, 19,21,22,[27][28][29][30][31][32] physicians, 30 or infection preventionists, 21,31 and others operate remotely and independently. In addition to PAF, some IDt ASPs provide didactic and case-based sessions led by IDt specialists during synchronous teleconferences.…”

Section: Telehealth-supported Antimicrobial Stewardshipmentioning

confidence: 99%

“…In addition to PAF, some IDt ASPs provide didactic and case-based sessions led by IDt specialists during synchronous teleconferences. 21,31 Participants in the teleconferences reported a positive experience, including a better understanding of the rationale for recommendations provided in real-time communications. Participants also felt that teleconferences enabled discussions between frontline clinicians and the stewardship team, which was preferable to asynchronous forms of communication.…”

Section: Telehealth-supported Antimicrobial Stewardshipmentioning

confidence: 99%

“…Participants also felt that teleconferences enabled discussions between frontline clinicians and the stewardship team, which was preferable to asynchronous forms of communication. 21 Studies on IDt ASPs have reported improved outcomes such as decreased inpatient antimicrobial use, 20,[23][24][25][26][28][29][30][31] decreased cost related to inpatient antimicrobials, 19,22,32 decreased Clostridioides difficile infections, 22,23 and improved antimicrobial susceptibility patterns of common organisms. 20,24,25,32 One study also reported a 40% increase in ID consultations after the implementation of IDt ASP.…”

Section: Telehealth-supported Antimicrobial Stewardshipmentioning

confidence: 99%

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Opportunities and challenges in improving antimicrobial use during the era of telehealth expansion: A narrative review

Suzuki

Shealy

Throneberry

et al. 2021

ASHE

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Efforts to improve antimicrobial prescribing are occurring within a changing healthcare landscape, which includes the expanded use of telehealth technology. The wider adoption of telehealth presents both challenges and opportunities for promoting antimicrobial stewardship. Telehealth provides 2 avenues for remote infectious disease (ID) specialists to improve inpatient antimicrobial prescribing: telehealth-supported antimicrobial stewardship and tele-ID consultations. Those 2 activities can work separately or synergistically. Studies on telehealth-supported antimicrobial stewardship have reported a reduction in inpatient antimicrobial prescribing, cost savings related to less antimicrobial use, a decrease in Clostridioides difficile infections, and improved antimicrobial susceptibility patterns for common organisms. Tele-ID consultation is associated with fewer hospital transfers, a shorter length of hospital stay, and decreased mortality. The implementation of these activities can be flexible depending on local needs and available resources, but several barriers may be encountered. Opportunities also exist to improve antimicrobial use in outpatient settings. Telehealth provides a more rapid mechanism for conducting outpatient ID consultations, and increasing use of telehealth for routine and urgent outpatient visits present new challenges for antimicrobial stewardship. In primary care, urgent care, and emergency care settings, unnecessary antimicrobial use for viral acute respiratory tract infections is common during telehealth encounters, as is the case for fact-to-face encounters. For some diagnoses, such as otitis media and pharyngitis, antimicrobials are further overprescribed via telehealth. Evidence is still lacking on the optimal stewardship strategies to improve antimicrobial prescribing during telehealth encounters in ambulatory care, but conventional outpatient stewardship strategies are likely transferable. Further work is warranted to fill this knowledge gap.

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Changes in antibiotic use following implementation of a telehealth stewardship pilot program

Cited by 18 publications

References 13 publications

Antibiotic Prescribing for Acute Rhinosinusitis: In‐Person Versus Virtual Visits During Covid‐19

Antibiotic Prescribing for Acute Rhinosinusitis: In‐Person Versus Virtual Visits During Covid‐19

Tele‐antimicrobial stewardship programs: A review of the literature and the role of the pharmacist

Opportunities and challenges in improving antimicrobial use during the era of telehealth expansion: A narrative review

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