Evaluation of a multifaceted approach to antimicrobial stewardship education methods for medical residents

Abstract

Objective:Medical residents are an important group for antimicrobial stewardship programs (ASPs) to target with interventions aimed at improving antibiotic prescribing. In this study, we compared antimicrobial prescribing practices of 2 academic medical teams receiving different ASP training approaches along with a hospitalist control group.Design:Retrospective cohort study comparing guideline-concordant antibiotic prescribing for 3 common infections among a family medicine (FM) resident service, an internal medicine (IM) resident service, and hospitalists.Setting:Community teaching hospital.Participants:Adult patients admitted between July 1, 2016, and June 30, 2017, with a discharge diagnosis of pneumonia, cellulitis, and urinary tract infections were reviewed.Methods:All 3 medical teams received identical baseline ASP education and daily antibiotic prescribing audit with feedback via clinical pharmacists. The FM resident service received an additional layer of targeted ASP intervention that included biweekly stewardship-focused rounds with an ASP physician and clinical pharmacist leadership. Guideline-concordant prescribing was assessed based on the institution’s ASP guidelines.Results:Of 1,572 patients, 295 (18.8%) were eligible for inclusion (FM, 96; IM, 69; hospitalist, 130). The percentage of patients receiving guideline-concordant antibiotic selection empirically was similar between groups for all diagnoses (FM, 87.5%; IM, 87%; hospitalist, 83.8%; P = .702). No differences were observed in appropriate definitive antibiotic selection among groups (FM, 92.4%; IM, 89.1%; hospitalist, 89.9%; P = .746). The FM resident service was more likely to prescribe a guideline-concordant duration of therapy across all diagnoses (FM, 74%; IM, 56.5%; hospitalist, 44.6%; P < .001).Conclusions:Adding dedicated stewardship-focused rounds into the graduate medical curriculum demonstrated increased guideline adherence specifically to duration of therapy recommendations.

Outcomes of an ambulatory care pharmacist-led antimicrobial stewardship program within a family medicine resident clinic

“…This study also adds to the growing body of evidence showing the importance of ASP interventions involving physician residents to establish good prescribing habits early in practice. 15,17,18 Furthermore, these results support the finding that syndrome-specific interventions are successful in improving antibiotic prescribing in the outpatient setting. 19 Previous studies evaluating multifaceted approaches to implementing ASPs in outpatient settings have also demonstrated success when targeting syndrome-specific prescribing by combining educational interventions with EHR optimization and peer-to-peer comparison.…”

“…[7][8][9][10][11][12] Furthermore, few efforts have targeted medical residents, an important target for ASPs in establishing good habits for antibiotic prescribing. [13][14][15] Although infectious diseases (ID) practitioners typically serve as ASP leaders in inpatient settings, this resource may be scarce in the outpatient setting. Ambulatory care pharmacists (AMCPs) working within primary-care practice sites may serve a critical role as stewardship collaborators and leaders in the outpatient setting; they have established relationships with the provider team and skills needed to identify problematic trends in antimicrobial use and to provide active intervention.…”

Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital

“…The participation of the pharmacist within the health care team translates into a decrease in unnecessary costs, an increase in the quality of care and an improvement in the patient's quality of life. These results have led to the acceptance of this professional by other members of the health team [36][37][38][39][40][41]. To date, there is no clinical pharmacist at the target institution involved in the design, implementation and review of therapeutic protocols, including PAP.…”

Route and duration of antibiotic therapy in acute cellulitis: A systematic review and meta-analysis of the effectiveness and harms of antibiotic treatment

“…Eleven studies included inpatients and reported an average length of antibiotic treatment of 5-17 days. 40,46,48,49,[52][53][54]57,58 Clinical response rates were all above 85%, failure rates ranged from 5-12% and recurrence rates from 0-17%. Eleven studies, including those treated as outpatients/OPAT, reported an average length of IV therapy of 2-7 days and an average overall treatment duration of 6-10 days.…”