Breaking the Ambulatory Antibiotic Prescribing Cycle with All-Antibiotic Stewardship, Patient Stewardship, and Visit Stewardship

Linder, Jeffrey A.

doi:10.1093/cid/ciaa1170

Cited by 8 publications

(9 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…62 Most antibiotic-stewardship interventions have been targeted at clinic visits, long after a patient has decided to seek care and may have formed expectations for care and receiving antibiotics. 63…”

Section: Harms Of Inappropriate Ambulatory Antibiotic Usementioning

confidence: 99%

“…As one example, a letter could nudge patients to consider that their repeated antibiotic use could be an indicator of an alternative diagnosis or condition ("Your repeated symptoms could be due to a different problem, like allergies."). 63 To prevent inappropriate antibiotic prescribing at an in-person visit, nudges might prevent the visit in the first place. 63 , 114 Patients with respiratory symptoms might be defaulted into a previsit or online triage, or be set up with online monitoring in lieu of an in-person visit.…”

Section: Patient-facing Nudges About Antibiotic Use and Care-seekingmentioning

confidence: 99%

See 1 more Smart Citation

Behavioral Economics and Ambulatory Antibiotic Stewardship: A Narrative Review

Richards

Linder

2021

Clinical Therapeutics

Self Cite

View full text Add to dashboard Cite

Section: Harms Of Inappropriate Ambulatory Antibiotic Usementioning

confidence: 99%

Section: Patient-facing Nudges About Antibiotic Use and Care-seekingmentioning

confidence: 99%

Behavioral Economics and Ambulatory Antibiotic Stewardship: A Narrative Review

Richards

Linder

2021

Clinical Therapeutics

Self Cite

View full text Add to dashboard Cite

“…To observe the impact of stewardship interventions on overall antibiotic prescribing in urgent care clinics, we measured antibiotic prescribing regardless of diagnosis or visit type. 19 Patients were not excluded from the all-antibiotic measure for competing diagnosis and/or comorbid condition history.…”

Section: All-antibiotic Measurementioning

confidence: 99%

“…Interventions implemented in fiscal year 2019 (FY19) focused on improving antibiotic use for non–antibiotic-appropriate diagnoses, but we were also concerned about diagnosis shifting (ie, an increase in the number of related antibiotic-appropriate diagnoses), overall antibiotic prescribing, and maintaining patient satisfaction. 19…”

mentioning

confidence: 99%

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

Patel

Madani

et al. 2022

Infect. Control Hosp. Epidemiol.

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…On the one hand, overprescribing may be fuelled by quality of care shortcomings—from structural factors (eg, lack of treatment guidelines, lack of clinical training or education about AMR) to inadequate process quality of care (eg, insufficient effort of providers during consultations) 14. On the other hand, antibiotics overprescribing may be driven by the willingness of providers to satisfy patients 15 16. Providers may go against their best clinical judgement and seek to satisfy what they believe patients expect17 18—a motive potentially stronger in the private sector, where providers compete for patients.…”

Section: Introductionmentioning

confidence: 99%

Levels and determinants of overprescribing of antibiotics in the public and private primary care sectors in South Africa

Lagarde,

Blaauw

2023

BMJ Glob Health

View full text Add to dashboard Cite

Although overprovision of antibiotics in primary care is a key driver of antibiotic resistance, little is known about its determinants in low-income and middle-income countries. Patient demand and financial incentives for providers are often held responsible for overprovision. Yet, inadequate provision exists in their absence and could be fuelled by quality of care issues and incorrect beliefs of providers regarding patients’ expectations. We explored these issues in the private and public sector in South Africa, by conducting a cross-sectional study using standardised patients (SPs)—healthy individuals trained to portray a scripted clinical case to providers—presenting with symptoms of a viral respiratory infection in a sample of public and private sector clinics. We linked data from SP visits to rich survey data to compare the practices and their predictors in the two sectors. Unnecessary rates of antibiotics were similarly high in the public (78%) and private sector (67%), but private providers prescribed more antibiotics at higher risk of resistance development. In the private sector, overprescription of antibiotics diminished when consultations were more thorough, but increased for consultations scheduled later in the day, suggesting contrasting effects for provider effort and decision fatigue. We observed differences in beliefs that could be responsible for overprescription: in the public sector, a majority of providers (nurses) wrongly believed that antibiotics would help the patient recover more quickly. In the private sector, a majority of doctors thought patients would not come back if they did not receive antibiotics. Overall, this evidence suggests that different factors may be responsible for the high overprescribing rates of antibiotics in the public and private sectors. Tailored stewardship interventions are urgently needed that tackle providers’ engrained habits and incorrect beliefs.

show abstract

Breaking the Ambulatory Antibiotic Prescribing Cycle with All-Antibiotic Stewardship, Patient Stewardship, and Visit Stewardship

Cited by 8 publications

References 32 publications

Behavioral Economics and Ambulatory Antibiotic Stewardship: A Narrative Review

Behavioral Economics and Ambulatory Antibiotic Stewardship: A Narrative Review

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

Levels and determinants of overprescribing of antibiotics in the public and private primary care sectors in South Africa

Contact Info

Product

Resources

About