The impact of educational interventions on antibiotic prescribing for acute upper respiratory tract infections in the ambulatory care setting: A quasi‐experimental study

Abstract

Objective: To identify the proportion of viral acute upper respiratory tract infections (AURTI) inappropriately treated with antibiotics before and after the implementation of a multimodal outpatient antibiotic stewardship initiative in a real-world setting.Design: Pre-post, quasi-experimental study. Patients: Adult patients with a diagnosis of either acute bronchitis, influenza, unspecified viral infection, or unspecified AURTI who visited internal medicine (IM) or family medicine (FM) ambulatory care clinics at an urban, academic health system in 2016 and 2017. Interventions: Provider education including the dissemination of an institutional guideline and algorithm for the treatment of AURTI occurred in FM and IM clinics. In the FM clinics, a roundtable discussion with clinicians promoting safe and appropriate antibiotic prescribing was conducted, and patient-facing educational posters were placed in exam rooms and clinic waiting areas describing the FM teams' commitment to using antibiotics only when necessary. Results: A total of 2817 patient encounters met study inclusion criteria. In total, inappropriate antibiotic prescribing had a relative decrease of 24% after implementation of the interventions (17.2% [235/1362] preintervention vs 13.1% [191/1455] postintervention; P = .02). During the preintervention period, 25.4% (143/563) of the encounters in the IM clinics were associated with inappropriate antibiotic prescribing compared with 19% (108/568) in the postintervention period (P < .01). Relative to the IM clinics, the FM clinics had a lower proportion of encounters associated withinappropriate antibiotic prescribing at baseline. In FM clinics, 11.5% (92/799) of encounters were associated with inappropriate antibiotic prescribing during the preintervention period compared with 9.4% (83/887) during the postintervention period (P = .15).

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

“…6 Despite guidance from the CDC to establish outpatient ASPs, literature examining successful ASP interventions within primary care sites is limited; most studies target upper respiratory tract infections (URIs). [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.…”

From concept to reality: Building an ambulatory antimicrobial stewardship program

“…21 Similarly, another study evaluated the effect of pharmacist educational intervention on the rate of antimicrobial prescribing in upper respiratory infections (acute bronchitis, influenza, unspecified viral infection, and URI). 23 The intervention was multimodal including creation and dissemination of guidelines/clinical pathways for the management of URI, roundtable discussions with providers outlining appropriate antimicrobial usage, and display of patient-facing antimicrobial commitment posters in clinics. As a result of educational intervention, a combined prescribing rate for internal medicine and family medicine clinic visits for these disease states demonstrated an absolute decrease from 17.2% to 13.1% (P = .02), with a relative decrease in inappropriate prescribing of 24% during the study period.…”

“…As a result of educational intervention, a combined prescribing rate for internal medicine and family medicine clinic visits for these disease states demonstrated an absolute decrease from 17.2% to 13.1% (P = .02), with a relative decrease in inappropriate prescribing of 24% during the study period. 23…”

“…The content of education provided is also likely to vary depending on the annual ASP goals selected, audience, delivery method, and duration; however, specific attention should be given to the provision of education highlighting the background, data, and specifics of the established organizational ASP goal and intended strategies to improve antimicrobial prescribing 5,7 . In the absence of more active intervention strategies as outlined above, isolated educational interventions are unlikely to contribute to sustained change in prescribing practices, thus many interventions that have shown an improvement in guideline‐concordant prescribing have utilized a multimodal interventional approach 17,22‐28 …”

Influenza colloidal gold method and blood routine tests combination for rapid diagnosis of influenza: a decision tree-based analysis

“…Craddock et al 3 reported that 17.2 and 25.4% of viral acute upper respiratory tract infections (AURTI) were inappropriately treated with antibiotics at urban internal medicine (IM) and family medicine (FM) ambulatory care clinics, respectively. A previous study reported that, among 6136 patients with acute respiratory infections (ARIs), 2522 (41%) had diagnoses for which antibiotics are not indicated; moreover, 2106 (84%) patients were diagnosed as having a viral upper respiratory tract infection or bronchitis 4 .…”