Pediatric Urgent Care Providers' Approach to Antibiotic Stewardship

Abstract

Background: Outpatient antibiotic prescribing for acute respiratory conditions is highest in urgent care settings; however, this has not been studied among pediatric urgent cares. The objective of this study was to evaluate pediatric urgent care providers' perceptions of antibiotic stewardship.Methods: Members of the Society for Pediatric Urgent Care were recruited via email to participate in a quality improvement antibiotic stewardship project. A preimplementation survey was sent to participants via email in March 2019 to evaluate perceptions on antibiotic stewardship. Descriptive statistics were used to analyze the survey responses.Results: A total of 156 providers completed the survey; 83% were board-certified pediatricians. Almost all (98%) indicated that antibiotic stewardship interventions are important for optimizing antibiotic use in urgent care. More than half (53%) indicated that their urgent care provided guidelines for prescribing antibiotics for acute respiratory tract infections. Treating patients with an underlying complex medical condition was the most common reason (21%) providers would deviate from guidelines. The most commonly cited barriers to appropriate prescribing for acute respiratory infections were patient expectations (93%), psychosocial barriers (40%), lack of clear evidence-based recommendations (15%), and lack of access to guidelines on prescribing (15%).Conclusions: Parental expectation of receiving antibiotics was viewed as the most common barrier to appropriate prescribing. These findings should be used to target directed interventions such as shared decision making and communication training to support appropriate antibiotic prescribing in pediatric urgent care.

Antimicrobial Stewardship in Pediatric Emergency Medicine: A Narrative Exploration of Antibiotic Overprescribing, Stewardship Interventions, and Performance Metrics

“…Clinicians working in the ED often perceive a demand for antibiotics from the caregiver [ 20 ]. Yet, studies examining the drivers behind ED attendance commonly reveal that caregivers primarily seek explanations for their child’s fever, reassurance, and guidance on symptom management [ 21 , 22 , 23 ].…”

Communication Strategies to Improve Antibiotic Prescribing in Pediatric Urgent Care Centers

“…In a national survey of pediatric UC providers, 93% of clinicians reported family expectations as a barrier to following antibiotic stewardship guidelines 4 . However, Mangione-Smith et al 5 demonstrated that providers are not good predictors of family expectations.…”