September 30, 2021
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Keller SC et al. Executive Summary 161. Presented at: IDWeek; September 29th-Oct. 02/03/2021 (virtual meeting).
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Keller and Miller do not report any relevant financial information. Please refer to the study for all relevant financial information from the other authors.
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A national antibiotic stewardship program was linked to a decline in antibiotic prescriptions in nearly 300 outpatient care facilities, mostly primary and emergency practices, according to the data presented at IDWeek.
The project is part of the HHS Agency for Healthcare Research and Quality (AHRQ) efforts to combat antibiotic resistance in the United States.
Sara C. Keller
Melissa A. Miller
It “focuses on the outpatient cohort of a five-year implementation project that aimed to improve antibiotic stewardship in three different care areas: acute care, long-term care and outpatient care by building antibiotic stewardship from the bottom up and redesigning administration as an important approach to patient safety “, Sara C. Keller, MD, MPH, MSPH, Assistant Professor of Medicine at the Johns Hopkins University School of Medicine, and Melissa A. Miller, MD, MS, FCCM, an AHRQ medical officer, Healio said in a joint response.
“Most antibiotics prescribed are prescribed in outpatient settings where antibiotic stewardship is an unmet need and we don’t know as much about how to use stewardship in outpatient care,” they said. “These results provide an insight into how antibiotic stewardship can be implemented in outpatient care.”
Researchers used webinars, audio presentations, training tools, and consultation hours to educate clinicians and HR managers on sensible antibiotic prescribing and to incorporate best practices for treating common infections.
For the study, they collected data on total visits, visits for acute respiratory infections and antibiotic prescriptions and compared the results from the prevention phase (September to November 2019) and the intervention phase (December 2019 to November 2020).
A total of 467 practices were enrolled and 389 (83%) completed the program, including 162 practices for basic care, 160 practices for emergency care and 49 federally supported practices, the researchers reported. Of these, 292 practices submitted complete data from a total of 6,590,485 visits.
The data showed that total visits per practice month decreased between March and May 2020 but gradually returned to baseline by the end of the program, while ARI visits per practice month decreased significantly between March and May 2020 – followed by an increase – but overall stayed below baseline through the end of the program.
They found that the total number of antibiotic prescriptions decreased by about nine prescriptions per 100 visits (95% CI, -10 to -8) – from 18.2 in September 2019 to 9.5 in November 2020. ARI-related Antibiotic prescriptions decreased by about 15 per 100 ARI visits by the end of the program (95% CI, -17 to -12), from 39.2 to 24.7, with penicillin-class prescriptions falling the most are.
“We know it is possible to improve the prescribing of antibiotics, but there is even less understanding of how to do it, especially in the outpatient setting,” said Keller and Miller. “These results show that with some tools and resources and practice dedication, outpatient practice members can work together to improve antibiotic prescribing.”
They said the program could serve as a model for outpatient practices and they plan to release a toolkit next year to facilitate nationwide implementation.
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