Clinical impact of pharmacist-led antibiotic stewardship programs in outpatient settings in the United States: A scoping review

Abstract

Purpose To provide an overview of the impact of pharmacist interventions on antibiotic prescribing and the resultant clinical outcomes in an outpatient antibiotic stewardship program (ASP) in the United States. Methods Reports on studies of pharmacist-led ASP interventions implemented in US outpatient settings published from January 2000 to November 2020 and indexed in PubMed or Google Scholar were included. Additionally, studies documented at the ClinicalTrials.gov website were evaluated. Study selection was based on predetermined inclusion criteria; only randomized controlled trials, observational studies, nonrandomized controlled trials, and case-control studies conducted in outpatient settings in the United States were included. The primary outcome was the observed differences in antibiotic prescribing or clinical benefits between pharmacist-led ASP interventions and usual care. Results Of the 196 studies retrieved for full-text review, a cumulative total of 15 studies were included for final evaluation. Upon analysis, we observed that there was no consistent methodology in the implementation of ASPs and, in most cases, the outcome of interest varied. Nonetheless, there was a trend toward improvement in antibiotic prescribing with pharmacist interventions in ASPs compared with that under usual care (P < 0.05). However, the results of these studies are not easily generalizable. Conclusion Our findings suggest a need for a consistent approach for the practical application of outpatient pharmacist-led ASPs. Managed care organizations could play a significant role in ensuring the successful implementation of pharmacist-led ASPs in outpatient settings.

A multimodal intervention to decrease inappropriate outpatient antibiotic prescribing for upper respiratory tract infections in a large integrated healthcare system

“…8,11,28 Previous studies have evaluated educational interventions, EHR-based interventions, or evaluation of peer-to-peer feedback individually. [8][9][10][29][30][31][32][33][34] In a recent Canadian trial, sending a single peer-comparison letter to primary-care physicians in the highest quartile of antibiotic prescribers decreased overall prescribing and prolonged-duration prescribing. 28 Those letters contained recommendations and education, signed by medical leaders.…”

Group B Streptococcus Screening and Treatment Adherence in Pregnancy: A Retrospective Cohort Study and Opportunities for Improvement

“…Similar programs targeted to clinics and providers with high levels of inappropriate antibiotic use, across specialties and care settings, may prove fruitful. [34] Our surveillance identified potential areas to target for improvement. These areas include proper documentation of outside test results and reasons for non-adherence, especially when early testing is performed.…”

Impact of pharmacist intervention in antibiotic stewardship programmes for critically ill neonates: A systematic review and meta‐analysis

“…Antibiotic stewardship programmes (ASPs) are aimed at reducing the incidence of antibiotic‐related adverse events and antibiotic cost and maximizing the clinical efficacy of antibiotics 1 . It has been reported that in pharmacist‐driven ASPs for adult patients, days of therapy (DOT) with antibiotics reduced and antibiotic prescription improved 2,3 . Furthermore, the inclusion of infectious diseases pharmacists or physicians in ASPs was associated with reduced total antibiotic use and exposure among in‐patients 4 .…”

“…1 It has been reported that in pharmacist-driven ASPs for adult patients, days of therapy (DOT) with antibiotics reduced and antibiotic prescription improved. 2,3 Furthermore, the inclusion of infectious diseases pharmacists or physicians in ASPs was associated with reduced total antibiotic use and exposure among in-patients. 4 Proper antibiotic use is important in neonates.…”