3 results
Comparison of diagnosis and prescribing practices between virtual visits and office visits for adults diagnosed with uncomplicated urinary tract infections within a primary care network
- Kaitlyn L. Johnson, Lisa E. Dumkow, Lisa A. Salvati, Kristen M. Johnson, Megan A. Yee, Nnaemeka E. Egwuatu
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 42 / Issue 5 / May 2021
- Published online by Cambridge University Press:
- 29 October 2020, pp. 586-591
- Print publication:
- May 2021
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- Article
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Objectives:
Telemedicine visits are an increasingly popular method of care for mild infectious complaints, including uncomplicated urinary tract infections (UTIs), and they are an important target for antimicrobial stewardship programs (ASPs) to evaluate quality of prescribing. In this study, we compared antimicrobial prescribing in a primary care network for uncomplicated UTIs treated through virtual visits and at in-office visits.
Design:Retrospective cohort study comparing guideline-concordant antibiotic prescribing for uncomplicated UTI between virtual visits and office visits.
Setting:Primary care network composed of 44 outpatient sites and a single virtual visit platform.
Patients:Adult female patients diagnosed with a UTI between January 1 and December 31, 2018.
Methods:Virtual visit prescribing was compared to office visit prescribing, including agent, duration, and patient outcomes. The health system ASP provides annual education to all outpatient providers regarding local antibiogram trends and prescribing guidelines. Guideline-concordant therapy was assessed based on the network’s ASP guidelines.
Results:In total, 350 patients were included, with 175 per group. Patients treated for a UTI through a virtual visit were more likely to receive a first-line antibiotic agent (74.9% vs 59.4%; P = .002) and guideline-concordant duration (100% vs 53.1%; P < .001). Patients treated through virtual visits were also less likely to have a urinalysis (0% vs 97.1%; P < .001) or urine culture (0% vs 73.1%; P < .001) ordered and were less likely to revisit within 7 days (5.1% vs 18.9%; P < .001).
Conclusions:UTI care through a virtual visit was associated with more appropriate antimicrobial prescribing compared to office visits and decreased utilization of diagnostic and follow-up resources.
Contributors
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- By Tod C. Aeby, Melanie D. Altizer, Ronan A. Bakker, Meghann E. Batten, Anita K. Blanchard, Brian Bond, Megan A. Brady, Saweda A. Bright, Ellen L. Brock, Amy Brown, Ashley Carroll, Jori S. Carter, Frances Casey, Weldon Chafe, David Chelmow, Jessica M. Ciaburri, Stephen A. Cohen, Adrianne M. Colton, PonJola Coney, Jennifer A. Cross, Julie Zemaitis DeCesare, Layson L. Denney, Megan L. Evans, Nicole S. Fanning, Tanaz R. Ferzandi, Katie P. Friday, Nancy D. Gaba, Rajiv B. Gala, Andrew Galffy, Adrienne L. Gentry, Edward J. Gill, Philippe Girerd, Meredith Gray, Amy Hempel, Audra Jolyn Hill, Chris J. Hong, Kathryn A. Houston, Patricia S. Huguelet, Warner K. Huh, Jordan Hylton, Christine R. Isaacs, Alison F. Jacoby, Isaiah M. Johnson, Nicole W. Karjane, Emily E. Landers, Susan M. Lanni, Eduardo Lara-Torre, Lee A. Learman, Nikola Alexander Letham, Rachel K. Love, Richard Scott Lucidi, Elisabeth McGaw, Kimberly Woods McMorrow, Christopher A. Manipula, Kirk J. Matthews, Michelle Meglin, Megan Metcalf, Sarah H. Milton, Gaby Moawad, Christopher Morosky, Lindsay H. Morrell, Elizabeth L. Munter, Erin L. Murata, Amanda B. Murchison, Nguyet A. Nguyen, Nan G. O’Connell, Tony Ogburn, K. Nathan Parthasarathy, Thomas C. Peng, Ashley Peterson, Sarah Peterson, John G. Pierce, Amber Price, Heidi J. Purcell, Ronald M. Ramus, Nicole Calloway Rankins, Fidelma B. Rigby, Amanda H. Ritter, Barbara L. Robinson, Danielle Roncari, Lisa Rubinsak, Jennifer Salcedo, Mary T. Sale, Peter F. Schnatz, John W. Seeds, Kathryn Shaia, Karen Shelton, Megan M. Shine, Haller J. Smith, Roger P. Smith, Nancy A. Sokkary, Reni A. Soon, Aparna Sridhar, Lilja Stefansson, Laurie S. Swaim, Chemen M. Tate, Hong-Thao Thieu, Meredith S. Thomas, L. Chesney Thompson, Tiffany Tonismae, Angela M. Tran, Breanna Walker, Alan G. Waxman, C. Nathan Webb, Valerie L. Williams, Sarah B. Wilson, Elizabeth M. Yoselevsky, Amy E. Young
- Edited by David Chelmow, Virginia Commonwealth University, Christine R. Isaacs, Virginia Commonwealth University, Ashley Carroll, Virginia Commonwealth University
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- Book:
- Acute Care and Emergency Gynecology
- Published online:
- 05 November 2014
- Print publication:
- 30 October 2014, pp ix-xiv
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Within-field spatial distribution of Cephus cinctus (Hymenoptera: Cephidae) larvae in Montana wheat fields
- Christian Nansen, David K. Weaver, Sharlene E. Sing, Justin B. Runyon, Wendell L. Morrill, Matthew J. Grieshop, Courtney L. Shannon, Megan L. Johnson
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- Journal:
- The Canadian Entomologist / Volume 137 / Issue 2 / April 2005
- Published online by Cambridge University Press:
- 02 April 2012, pp. 202-214
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- Article
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The wheat stem sawfly, Cephus cinctus Norton, is a major insect pest in dryland wheat (Triticum L. spp.; Poaceae) fields in the northern Great Plains of the United States and in southern regions of the prairie provinces of Canada. Field infestations by this pest commonly show a distinct “edge effect”, with infestation levels highest at the field edge and declining inwards. In this study, we characterized the edge effect of C. cinctus infested wheat fields in Montana at four locations in two separate years. "Infestation level" refers to the average proportion of wheat stems infested with C. cinctus in samples collected in a given wheat field. The gradual decrease in C. cinctus infestation towards the centre of wheat fields is referred to as the “infestation slope”, and it was presented as a proportion of infestation level at field edges. We showed that (i) for most of the fields bordering grassland or fallow wheat, a simple exponential decline curve provided a significant fit to the infestation slope; (ii) the infestation slopes in different fields and in different directions within fields were similar and appeared to be independent of the overall infestation level; and (iii) the relationship between infestation level and the proportion of samples infested followed an asymptotic curve, which indicates a high level of dispersal of ovipositing C. cinctus females. The general perception has been that the edge effect of C. cinctus infestation is a result of ovipositing C. cinctus females being both weak flyers and short-lived, but our results do not fully corroborate this perception. Currently, the only reliable way to detect C. cinctus infestations is to dissect individual stems and look for developing instars. However, this type of sampling is extremely time consuming and labor intensive and therefore impractical for wheat growers. Increasing the understanding of the spatial patterns in C. cinctus infestations is a first step towards development of an optimal sampling plan for this important field pest. Thus, the results presented are relevant for researchers involved in sampling designs and integrated pest management procedures for field pests. We discuss behavioral and evolutionary factors that may contribute to the edge effect of C. cinctus infestations.