Effect of prescriber peer comparison reports on fluoroquinolone use across a 16‐facility community hospital system

Abstract

Introduction Antimicrobial stewardship programs (ASPs) continuously strive to optimize antibiotic use, while minimizing antibiotic‐associated adverse events. Among potential targets for antibiotic use reduction, fluoroquinolones (FQs) are an attractive drug class for ASPs due to their wide spectrum of activity, known adverse event profile, and availability of less toxic therapeutic options. The use of peer comparison on antibiotic use by ASPs has been described but is limited primarily to the outpatient setting. Objectives To assess the impact of peer comparison using prescriber‐specific reports on FQ use and hospital‐acquired Clostridioides difficile rates across a 16‐facility community hospital system. Methods In January 2017, we began providing quarterly facility‐specific peer comparison reports to high‐volume antibiotic prescribers in three different medical specialties across our health‐system: Internal Medicine/Hospitalists/Family Medicine, Intensivists/Pulmonologists, and infectious diseases (ID). We completed a quasi‐experimental study designed to assess aggregated hospital data, evaluating FQ days of therapy/1000 patient days (DOT/1000 PD) in the intervention period (January‐December 2017), and compared with the baseline period (January‐December 2016). Additional outcomes that were evaluated include total antibiotic consumption (DOT/1000 PD), total percentage of antibiotics attributable to FQs, and cases of hospital‐acquired C. difficile/10000 PD (HA‐CD). Results Compared with the baseline period, FQ use decreased by 29% (baseline—83.9 DOT/1000 PD; intervention—58.5 DOT/1000 PD; P < 0.001). The overall percentage of antibiotics that were attributable to FQs also decreased in the intervention period (baseline—15.4%; intervention—11.3%; P < 0.001). During the intervention period, there were no significant increases in other key antibiotic classes, including antipseudomonal beta‐lactams and third‐generation cephalosporins. The rate of HA‐CD decreased by 20% in the intervention period compared with baseline. Conclusion In a large community hospital system, the use of peer comparison reports based on prescriber specialty reduced FQ use, and may potentially reduce adverse events associated with FQ use.

Systematic review of clinician-directed nudges in healthcare contexts

“…Multicomponent intervention studies organised according to nudge ladder Cochrane risk of bias assessment tool Allen et al36 (2019, USA) Andereck et al37 (2019, USA) Arora et al38 (2019, USA) …”

FDA collaboration to improve safe use of fluoroquinolone antibiotics: an ex post facto matched control study of targeted short-form messaging and online education served to high prescribers

“…The increased effectiveness of messaging combined with CME, as compared with messaging alone, is suggested by another recent study that showed a 29% decrease in fluoroquinolone prescribing among high-volume antibiotic prescribers who received peer comparison reports that included education about ways to reduce fluoroquinolone utilization for common diseases such as lower respiratory tract infections and asymptomatic bacteriuria. 23 The study investigators cited the educational feature as a possible explanation for the positive results achieved compared with a Swiss study that did not show any differences in outpatient antibiotic utilization after an intervention that provided peer prescriber comparison reports -but did not provide any educational resources -to prescribers. 24 Our results also suggest that targeted short-form messages paired with online CME may be a viable alternative to other tactics that, depending on the systems that may or not be in place to carry out these tactics, are thought to be more time-consuming (e.g., carbon copy prescription pads that require collection and evaluation; telephone interviews with patients; day-long, small-group, academic detailing meetings plus follow-up meetings; point of care clinical decision support tools which require several weeks training), expensive (e.g., electronic clinical decision support systems; incentive payments for program participation), and not easily scalable (small group training sessions in communication skills; practice profiling for prescribing rates) drivers of practice change.…”