Telemedicine as an effective intervention to improve antibiotic appropriateness prescription and to reduce costs in pediatrics

Abstract

Implementation of antimicrobial stewardship program is a pivotal practice element for healthcare institution. We developed a remote infectious disease consultancy program via telemedicine in a high-specialized pediatric cardiac hospital. A consultation for antibiotic strategy for each patient was available via telemedicine in addition to biweekly discussion of all clinical cases. Aim of this study was to evaluate the impact of the remote stewardship program in terms of a) appropriateness of antibiotic prescription; b) incidence of multi-resistant infection; and c) cost. A ‘before - after’ study was performed comparing the period immediately before starting the program and one year after. There was a trend in the reduction of nosocomial infectious disease rate (9.5 vs 6.5 per 1000 person days), with a reduction in the overall antibiotic cost (25,000 vs 15,000 EUR) and in the average antibiotics packages used per admission (9 vs 6.7 packages). A significant reduction in the multi-drug resistant isolation rate was observed (104 vs 79 per 1000 person days, p = 0.01). In conclusion, the infectious disease meeting via telemedicine has been an effective tool for economic and professional development and multidisciplinary management of complex patients. The appropriate use of antibiotics reduced the multi-drug resistant bacteria selection, thus improving patient safety.

Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

“…Thirty-nine (39/113, 34.5%) were multicentre studies: 43.6% (17/39) were set in the USA, 35.9% (14/39) in Europe, and the rest 20.5% in Asia and Africa (8/39). [52,58,66,67,72,106,112,115,124,137,141] as an outcome used mostly to analyse audit and feedback ASP [58,67,74,141]. In five cases, no changes were reported [58,66,74,106,115], while the other seven studies showed an increased susceptibility of the bacteria analysed [52,67,72,112,124,137,141].…”

“…[52,58,66,67,72,106,112,115,124,137,141] as an outcome used mostly to analyse audit and feedback ASP [58,67,74,141]. In five cases, no changes were reported [58,66,74,106,115], while the other seven studies showed an increased susceptibility of the bacteria analysed [52,67,72,112,124,137,141]. The most interesting results were a decrease in extended spectrum beta-lactamase (ESBL) producers E. coli and K. pneumoniae [72,112,124]; a reduction in the rate of P. aeruginosa carbapenem resistance subsequent to an observed reduction in the rate of antimicrobial days of therapy (DOT) [67,124]; and, in two studies set in outpatient setting, an increase in erythromycin-sensitive S. pyogenes following a reduction in the use of macrolides [137,141].…”

“…Eighteen papers (18/113, 15.9%)[40-42, 51, 54, 60, 71, 85, 87, 91, 98, 105, 106, 125, 135, 136, 138, 142] showed an increase in compliance among prescribing physicians; half of the papers analysing this outcome were from USA and Canada (10/18, 55.5%), and the main ASPs adopted were guidelines (9/34, 26.5%)[40,42,54,60,85,87,91,106,125,142], doctors education (5/34, 14.7%)[54,91,98,138,142] and other not common ASPs such as antibiotic order set[42,51], and checklists[87,91]. Sixteen of the included studies[16/113, 14.2% in total; 7/16 (43.7%) from USA, 6/16 (37.5%) from Asia and the rest (18.7%) from Europe] quantified cost savings related to the intervention[39,49,52,64,66,69,73,86,89,92,97,101,102,[122][123][124]. Decreases in costs were most often due to lower rates of drug administration.…”

Changes in antibiotic use following implementation of a telehealth stewardship pilot program

“…[7][8][9] Moreover, 4 reports have described tele-consultation interventions that used secure videoconference technology to bring individuals from remote locations together for regularly scheduled, multidisciplinary team meetings. [10][11][12][13] An additional publication describes an on-demand approach in which providers requested advice from an on-call infectious disease expert and received real-time feedback over the telephone and through the electronic medical record. 14 Of these 8 programs, 5 detailed quantifiable decreases in the use of antibiotics and prevalence of multidrugresistant pathogens or Clostridiodes difficile.…”

A pilot study using telehealth to implement antimicrobial stewardship at two rural Veterans Affairs medical centers

“…13,14 Synchronous programs used technology to permit a multidisciplinary team of professionals to discuss cases in real time and also allowed for consultation to occur outside of scheduled sessions. [15][16][17][18] In addition to infectious disease physicians and pharmacists, team members included epidemiologists, microbiologists, administrators, information technology specialists, infection control staff members, as well as other physicians. To help broaden the inclusion of antimicrobial stewardship principles across clinical disciplines, the VAST specifically involved staff nurses.…”