Rapid streptococcal pharyngitis testing and antibiotic prescribing before and during the coronavirus disease 2019 (COVID-19) pandemic

Seibert, Allan M; Stenehjem, Edward; Wallin, Anthony; Willis, Park W.; Brunisholz, Kim; Kumar, Naresh; Stanfield, Valoree; Fino, Nora; Shapiro, Daniel J.; Hersh, Adam L.

doi:10.1017/ash.2022.222

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…This overlap was associated with substantial health care disruptions and a reduction in outpatient antibiotic prescriptions nationwide . We and others have reported on the association of the pandemic with antibiotic prescribing during UC visits . Changes in the case mix of patients seeking care in UC centers could potentially have influenced prescribing rates.…”

Section: Discussionmentioning

confidence: 74%

“…25 We and others have reported on the association of the pandemic with antibiotic prescribing during UC visits. [25][26][27] Changes in the case mix of patients seeking care in UC centers could potentially have influenced prescribing rates. However, a sensitivity analysis conducted in the present study excluding the period of the pandemic showed no difference in the primary outcome.…”

Section: Discussionmentioning

confidence: 99%

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Implementation of an Antibiotic Stewardship Initiative in a Large Urgent Care Network

et al. 2023

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ImportanceUrgent Care (UC) encounters result in more inappropriate antibiotic prescriptions than other outpatient setting. Few stewardship interventions have focused on UC.ObjectiveTo evaluate the effectiveness of an antibiotic stewardship initiative to reduce antibiotic prescribing for respiratory conditions in a UC network.Design, Setting, and ParticipantsThis quality improvement study conducted in a UC network with 38 UC clinics and 1 telemedicine clinic included 493 724 total UC encounters. The study compared the antibiotic prescribing rates of all UC clinicians who encountered respiratory conditions for a 12-month baseline period (July 1, 2018, through June 30, 2019) with an intervention period (July 1, 2019, through June 30, 2020). A sustainability period (July 1, 2020, through June 30, 2021) was added post hoc.InterventionsStewardship interventions included (1) education for clinicians and patients, (2) electronic health record (EHR) tools, (3) a transparent clinician benchmarking dashboard, and (4) media. Occurring independently but concurrent with the interventions, a stewardship measure was introduced by UC leadership into the quality measures, including a financial incentive.Main Outcomes and MeasuresThe primary outcome was the percentage of UC encounters with an antibiotic prescription for a respiratory condition. Secondary outcomes included antibiotic prescribing when antibiotics were not indicated (tier 3 encounters) and first-line antibiotics for acute otitis media, sinusitis, and pharyngitis. Interrupted time series with binomial generalized estimating equations were used to compare periods.ResultsThe baseline period included 207 047 UC encounters for respiratory conditions (56.8% female; mean [SD] age, 30.0 [21.4] years; 92.0% White race); the intervention period included 183 893 UC encounters (56.4% female; mean [SD] age, 30.7 [20.8] years; 91.2% White race). Antibiotic prescribing for respiratory conditions decreased from 47.8% (baseline) to 33.3% (intervention). During the initial intervention month, a 22% reduction in antibiotic prescribing occurred (odds ratio [OR], 0.78; 95% CI, 0.71-0.86). Antibiotic prescriptions decreased by 5% monthly during the intervention (OR, 0.95; 95% CI, 0.94-0.96). Antibiotic prescribing for tier 3 encounters decreased by 47% (OR, 0.53; 95% CI, 0.44-63), and first-line antibiotic prescriptions increased by 18% (OR, 1.18; 95% CI, 1.09-1.29) during the initial intervention month. Antibiotic prescriptions for tier 3 encounters decreased by an additional 4% each month (OR, 0.96; 95% CI, 0.94-0.98), whereas first-line antibiotic prescriptions did not change (OR, 1.00; 95% CI, 0.99-1.01). Antibiotic prescribing for respiratory conditions remained stable in the sustainability period.Conclusions and relevanceThe findings of this quality improvement study indicated that a UC antibiotic stewardship initiative was associated with decreased antibiotic prescribing for respiratory conditions. This study provides a model for UC antibiotic stewardship.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Implementation of an Antibiotic Stewardship Initiative in a Large Urgent Care Network

et al. 2023

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“… 3 One study in urgent care demonstrated the utility of this metric by detecting a sudden increase in the AXR which enabled identifying the cause as an increased prescribing rate for pharyngitis due to the temporary elimination of rapid testing. 7 However, other than this temporary increase in prescribing, the onset of the COVID-19 pandemic did not lead to an abrupt decline in AXR in this health system likely due to a preceding stewardship intervention that had already reduced prescribing, especially for Tier 3 conditions, to a low level. 3 This may have been enhanced in part due to availability of point-of-care testing and education about not prescribing antibiotics for COVID-19.…”

Section: Discussionmentioning

confidence: 93%