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Antibiotic stewardship to reduce inappropriate antibiotic prescribing in integrated academic health-system urgent care clinics

Published online by Cambridge University Press:  13 July 2022

Dharmesh Patel ,
Teresa Ng ,
Lubna S. Madani ,
Stephen D. Persell ,
Mark Greg ,
Phillip E. Roemer ,
Sonali K. Oberoi  and
Jeffrey A. Linder Open the ORCID record for Jeffrey A. Linder [Opens in a new window]
Dharmesh Patel
Affiliation:
Quality and Patient Safety, Northwestern Medical Group, Chicago, Illinois
Teresa Ng
Affiliation:
Population Health Analytics, Northwestern Medicine, Chicago, Illinois
Lubna S. Madani
Affiliation:
Division of Immediate Care, Northwestern Medical Group, Chicago, Illinois
Stephen D. Persell
Affiliation:
Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois Center for Primary Care Innovation, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine Northwestern Medical Group, Chicago, Illinois
Mark Greg
Affiliation:
Ambulatory Pharmacy, Northwestern Medicine, Chicago, Illinois
Phillip E. Roemer
Affiliation:
Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois Northwestern Medical Group, Chicago, Illinois
Sonali K. Oberoi
Affiliation:
Northwestern Medical Group, Chicago, Illinois
Jeffrey A. Linder*
Affiliation:
Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois Center for Primary Care Innovation, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine Northwestern Medical Group, Chicago, Illinois
*
Corresponding author: Email jlinder@northwestern.edu
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Abstract

Objective:

To develop and implement antibiotic stewardship activities in urgent care targeting non–antibiotic-appropriate acute respiratory tract infections (ARIs) that also reduces overall antibiotic prescribing and maintains patient satisfaction.

Patients and setting:

Patients and clinicians at the urgent care clinics of an integrated academic health system.

Intervention and methods:

The stewardship activities started in fiscal 2020 and included measure development, comparative feedback, and clinician and patient education. We measured antibiotic prescribing in fiscal years 2019, 2020, and 2021 for the stewardship targets, potential diagnosis-shifting visits, and overall. We also collected patient satisfaction data for ARI visits.

Results:

From FY19 to FY21, 576,609 patients made 1,358,816 visits to 17 urgent care clinics, including 105,781 visits for which stewardship measures were applied and 149,691 visits for which diagnosis shifting measures were applied. The antibiotic prescribing rate decreased for stewardship-measure visits from 34% in FY19 to 12% in FY21 (absolute change, −22%; 95% confidence interval [CI], −23% to −22%). The antibiotic prescribing rate decreased for diagnosis-shifting visits from 63% to 35% (−28%; 95% CI, −28% to −27%), and the antibiotic prescribing rate decreased overall from 30% to 10% (−20%; 95% CI, −20% to −20%). The patient satisfaction rate increased from 83% in FY19 to 89% in FY20 and FY21. There was no significant association between antibiotic prescribing rates of individual clinicians and ARI visit patient satisfaction.

Conclusions:

Although it was affected by the COVID-19 pandemic, an ambulatory antimicrobial stewardship program that focused on improving non–antibiotic-appropriate ARI prescribing was associated with decreased prescribing for (1) the stewardship target, (2) a diagnosis shifting measure, and (3) overall antibiotic prescribing. Patient satisfaction at ARI visits increased over time and was not associated with clinicians’ antibiotic prescribing rates.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 5 , May 2023 , pp. 736 - 745
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION: We presented these findings as a poster (poster number P123) at the Vizient Connection Summit 2021, November 16-17, 2021, in Las Vegas, Nevada, and submitted as an abstract to the American Journal of Medical Quality.

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