Development and implementation of a clinical decision support tool for treatment of uncomplicated urinary tract infections in a family medicine resident clinic

Eudaley, Sarah T.; Mihm, Alexandra E.; Higdon, Rebecca; Jeter, Julie; Chamberlin, Shaunta’ M.

doi:10.1016/j.japh.2019.03.006

Cited by 25 publications

(34 citation statements)

References 11 publications

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“…They showed a 19.7% absolute reduction in inappropriate antibiotic prescribing for acute respiratory infections ( P = .02) 12 . A second study created a clinical decision support tool to improve guideline‐directed antibiotic prescribing for uncomplicated UTIs 21 . Fluoroquinolone use decreased from 42% to 15% ( P < .001), and no patients received empiric therapy with fluoroquinolones for uncomplicated UTIs.…”

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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Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…This concept has demonstrated improvement in guideline concordant antibiotic prescribing and reductions in the delivery of ineffective therapy. Eudaley et al 22 demonstrated that clinicians using CDSS tools increased guideline concordance for empiric therapy by 30%. Notably, integration of these tools reduced the frequency of ineffective antibiotic therapy by 40% in critically ill patients.…”

Section: Syndromic Antibiogramsmentioning

confidence: 99%

Antimicrobial stewardship and antibiograms: importance of moving beyond traditional antibiograms

Klinker

Hidayat

DeRyke

et al. 2021

Therapeutic Advances in Infection

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The rapid evolution of resistance, particularly among Gram-negative bacteria, requires appropriate identification of patients at risk followed by administration of appropriate empiric antibiotic therapy. A primary tenet of antimicrobial stewardship programs (ASPs) is the establishment of empiric antibiotic recommendations for commonly encountered infections. An important tool in providing empiric antibiotic therapy recommendations is the use of an antibiogram. While the majority of institutions use a traditional antibiogram, ASPs have an opportunity to enhance antibiogram data. The authors provide the rationale for why ASPs should implement alternative antibiograms, and the importance of incorporating an antibiogram into clinical decision support systems with the goal of providing effective empiric antibiotic therapy.

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“…A multidisciplinary team that included a pharmacist designed a clinical decision support tool to guide management of uncomplicated urinary tract infections. 32 This collaboration led to significant reductions in the use of fluoroquinolone (27%) and trimethoprim/sulfamethoxazole (20%), and increases in nitrofurantoin use for cystitis (31%) and guideline-directed duration of therapy (32%). 32 A multistate evaluation of a collaborative practice agreement between physicians and free-standing pharmacies found that pharmacists were able to accurately triage and manage patients presenting with influenzalike illness.…”

Section: Role Of Pharmacists In Outpatient Antimicrobial Stewardshipmentioning

confidence: 99%

“…32 This collaboration led to significant reductions in the use of fluoroquinolone (27%) and trimethoprim/sulfamethoxazole (20%), and increases in nitrofurantoin use for cystitis (31%) and guideline-directed duration of therapy (32%). 32 A multistate evaluation of a collaborative practice agreement between physicians and free-standing pharmacies found that pharmacists were able to accurately triage and manage patients presenting with influenzalike illness. 33 In this study, 35% of patients had no primary care physician and 39% visited outside of normal clinic hours; these findings demonstrate the potential value of care using this model.…”

Section: Role Of Pharmacists In Outpatient Antimicrobial Stewardshipmentioning

confidence: 99%

“…Laboratory testing-guided stewardship is also another area where pharmacists can have an impact. Previously mentioned pharmacist collaborations involved clinical decision support and triaging that resulted in improved stewardship outcomes for UTI 32 and influenza-like illness. 33 Pharmacist prospective review of cultures (predominantly urine) whenever outpatient oral antibiotics were prescribed in a New York Veterans' Affairs system found that~20% of prescription encounters with cultures resulted in pharmacist intervention and that 74% of interventions required a change in the antibiotic regimen.…”

Section: Financial Incentivesmentioning

confidence: 99%

See 1 more Smart Citation

Antimicrobial stewardship in the outpatient setting: A review and proposed framework

Marcelin

Chung

Schooneveld

2020

Infect. Control Hosp. Epidemiol.

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Development and implementation of a clinical decision support tool for treatment of uncomplicated urinary tract infections in a family medicine resident clinic

Cited by 25 publications

References 11 publications

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

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

Antimicrobial stewardship and antibiograms: importance of moving beyond traditional antibiograms

Antimicrobial stewardship in the outpatient setting: A review and proposed framework

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