In the outpatient setting, estimates suggest that 30% of the antibiotics prescribed are unnecessary. This study explores patient knowledge and awareness of appropriate use of antibiotics and expectations regarding how antibiotics are used for their treatment in outpatient settings. A survey was administered to a convenience sample of patients, parents, and caregivers (n = 190) at seven primary care clinics and two urgent care locations. Fisher’s exact tests compared results by patient characteristics. Although 89% of patients correctly believed that antibiotics work well for treating infections from bacteria, 53% incorrectly believed that antibiotics work well for treating viral infections. Patients who incorrectly believed that antibiotics work well for treating viral infections were more than twice as likely to expect a provider to give them an antibiotic when they have a cough or common cold. Patients who completed the survey also participated in semi-structured interviews (n = 4), which were analyzed using thematic analysis. Patients reported experiencing confusion about which illnesses may be treated by antibiotics and unclear communication from clinicians about the appropriate use of antibiotics. Development of easy to understand patient educational materials can help address patients’ incorrect perceptions of appropriate antibiotic use and facilitate patient-provider communication.

BackgroundInappropriate prescribing of antibiotics poses an urgent public health threat. Limited research has examined factors associated with antibiotic prescribing practices in outpatient settings. The goals of this study were to explore elements influencing provider decisions to prescribe antibiotics, identify provider recommendations for interventions to reduce inappropriate antibiotic use, and inform the clinical management of patients in the outpatient environment for infections that do not require antibiotics.MethodsThis was a qualitative study using semi-structured interviews with key informants. Seventeen outpatient providers (10 medical doctors and 7 advanced care practitioners) within a large healthcare system in Charlotte, North Carolina, participated. Interviews were audio recorded, transcribed, and analyzed for themes.ResultsPrimary barriers to reducing inappropriate antibiotic prescribing included patient education and expectations, system-level factors, and time constraints. Providers indicated they would be interested in having system-wide, evidence-based guidelines to inform their prescribing decisions and that they would also be receptive to efforts to improve their awareness of their own prescribing practices. Results further suggested that providers experience a high demand for antibiotic prescriptions; consequently, patient education around appropriate use would be beneficial.ConclusionsFindings suggest that antibiotic prescribing in the outpatient setting is influenced by many pressures, including patient demand and patient satisfaction. Training on appropriate antibiotic prescribing, guideline-based decision support, feedback on prescribing practices, and patient education are recommended interventions to improve levels of appropriate prescribing.

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Patients with dementia and their caregivers need ongoing educational and psychosocial support to manage their complex diagnosis. This mixed methods study evaluated the impact of a memory clinic with an embedded dementia navigator on the experiences and health outcomes of patients with dementia and their caregivers. At the 12-month follow-up, patients receiving memory clinic services ( n = 238) had higher emergency department visits than a matched cohort with dementia ( n = 938), although hospitalizations did not differ. Patient quality of life and caregiver burden scores also did not differ between baseline and 12-months. Interviews revealed that caregivers ( n = 12) valued the educational and social support components of the memory clinic and perceived that the clinic had a positive impact on their experiences. Findings suggest that this embedded navigator model is useful for addressing caregiver needs and may have potential to stem increases in caregiver burden and patient quality of life that occur with disease progression.

BackgroundAntibiotic stewardship programs are vital in the ambulatory setting to address the public health threat of antibiotic resistance. In 2016, the Centers for Disease Control and Prevention (CDC) released Core Elements of Outpatient Antibiotic Stewardship. These core elements were the basis for the development of the Carolinas HealthCare Outpatient Antimicrobial Stewardship Empowerment Network (CHOSEN), which collaborates with more than 150 Atrium Health ambulatory practices to improve antibiotic awareness across metropolitan, suburban and rural communities, touching approximately 1,060,000 patients.MethodsInitial baseline research involved surveys with 190 patients and key informant interviews with four patients and 17 providers. A resource working group was formed during a follow-up strategic planning session involving more than 40 multidisciplinary stakeholders. Key concepts identified through patient and provider engagement were the focus for the development of stewardship education and resources with involvement from physicians, nurses and pharmacists, as well as representation from quality, marketing and patient experience.ResultsIdentified opportunities were addressed with the design of a “Bacteria and Viruses” patient handout and symptoms checklists for over-the-counter recommendations for adults, teens and children—all with translation into an additional 11 languages; a commitment flyer for patient examination rooms; pediatric dosing guides for acetaminophen and ibuprofen; provider scripting; and two educational videos. Resources were introduced via a consumer webpage, a provider intranet site update, and media pitching featuring key providers in the community to coincide with the CDC’s National Antibiotic Awareness Week in November 2017. Additional focused provider and practice-site education sessions were held for ambulatory practice specialties of urgent care, family medicine, internal medicine and pediatrics.ConclusionThrough multidisciplinary collaboration, CHOSEN developed a better understanding of patient and provider attitudes and experiences that led to the development of specific tools and a campaign to meet the identified needs for antibiotic awareness in the community. Disclosures E. Gentry, Duke Endowment: Grant Investigator, Grant recipient. C. Sweeney, Duke Endowment: Grant Investigator, Grant recipient. M. Spencer, Duke Endowment: Grant Investigator, Grant recipient. Eli Lilly and Company: Grant Investigator, Grant recipient. E. Handy, Duke Endowment: Grant Investigator, Grant recipient. L. Davidson, Duke Endowment: Grant Investigator, Grant recipient.