Expanding Antimicrobial Stewardship to Urgent Care Centers Through a Pharmacist-Led Culture Follow-up Program

Dumkow, Lisa E.; Beuschel, Thomas; Brandt, Kasey L.

doi:10.1007/s40121-017-0168-8

Cited by 29 publications

(15 citation statements)

References 10 publications

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“…Similarly, observing the benefits of AMS involvement on improved outcomes such as appropriate microbiological specimens being taken and receipt of directed therapy are also not surprising. Other studies with pharmacist-led initiatives have shown similar results and improved overall appropriateness of antimicrobial therapy [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 71%

'Careful goodbye at the door': is there role for antimicrobial stewardship interventions for antimicrobial therapy prescribed on hospital discharge?

Chavada¹,

Davey

O’Connor

et al. 2018

BMC Infect Dis

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BackgroundAntimicrobial stewardship (AMS) interventions largely target inpatient antimicrobial prescribing. Literature on appropriateness of antimicrobials prescribed at the interface between hospital and the community is minimal. This study was designed to assess the appropriateness of antimicrobials prescribed on hospital discharge and evaluate the impact of AMS interventions.MethodsPatients with discharge medications processed by the pharmacy were identified using a computerized pharmacy medication tracker over a four week period. The antimicrobials prescribed on discharge were assessed independently for appropriateness of antimicrobial choice, dose, frequency and duration. Data on various AMS interventions was collected. Univariate followed by multivariate logistic regression (MVLR) analysis was performed using SPSS V 23 (IBM, California).ResultsA total of 892 discharge prescriptions were processed by the pharmacy department, 236 of which contained antibiotic prescriptions. Of these, 74% were appropriate for antimicrobial choice, 64% for dose, 64% for frequency and 21% for duration. In particular, 71% of patients received a course in excess of Therapeutic Guidelines-Australia(TG-A) recommended length of treatment. On univariate analysis, discharge antimicrobial prescriptions were more likely to be appropriate for antimicrobial choice, frequency and duration; appropriate microbiological specimens were more likely to be taken and targeted therapy more likely to be given when the AMS team was involved. On MVLR, appropriateness with antimicrobial dosing frequency [OR 5.6(1.9–19.2)], microbiological specimens [OR 4.3(1.6–11.6)] and receipt of targeted therapy [OR 2.8(1.8–6.2)] with AMS involvement remained significant.ConclusionsA large discrepancy exists between antimicrobial regimens prescribed on hospital discharge and those recommended in consensus guidelines, particularly concerning duration of treatment. While AMS interventions are well established for improving antimicrobial prescribing in hospital inpatients, the hospital-community interface remains a challenge in terms of antimicrobial prescribing and exposes patients to potential harm. There is a clear need for AMS interventions to extend to antimicrobial therapy prescribed on discharge.

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Section: Discussionmentioning

confidence: 71%

'Careful goodbye at the door': is there role for antimicrobial stewardship interventions for antimicrobial therapy prescribed on hospital discharge?

Chavada¹,

Davey

O’Connor

et al. 2018

BMC Infect Dis

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show abstract

“…These stewardship interventions did not utilize a pharmacist. More recent literature evaluated the impact of a pharmacist‐led culture follow‐up program in the UC setting 17‐19 . Dumkow and colleagues demonstrated the impact of a pharmacist on decreasing antibiotic use through a collaborative practice agreement in asymptomatic patients with positive GAS cultures originally seen in the emergency department/UC.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a pharmacist's impact on antimicrobial prescribing in an urgent care center

Fabian

Blaine

Linnertz

et al. 2020

J Am Coll Clin Pharm

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Introduction The urgent care (UC) setting is an opportunity for pharmacists to promote antimicrobial stewardship (AS). Objectives The primary objective is to determine compliance with antibiotic prescribing recommendations for the treatment of urinary tract infections (UTI), skin and soft tissue infections (SSTI), upper respiratory tract infections (URI), and lower respiratory tract infections (LRTI) before, during, and after the presence of an AS pharmacist in an UC. Methods Single‐center, retrospective, observational, pre‐ (December 10, 2018‐January 6, 2019), intervention (January 7, 2019‐February 3, 2019), and post‐ (February 4, 2019‐March 3, 2019) study. All nonpregnant, adult patients with a chief complaint consistent with UTI, SSTI, URI, or LRTI were included. Patients transferred to another facility, not seen by a provider, presented for a follow‐up visit, with multiple sites of infection, or treated for a bite, wound, or surgical site infection were excluded. Compliance was a composite end point of guideline adherent antibiotic prescribing, empiric selection, duration, and/or dosage. Secondary outcomes included composite outcome components and subgroup analysis of disease states. Logistic regression was performed to evaluate the intervention and other predictors of compliance. Results A total of 1930 patients were screened with 439 440, and 430 patients included in the pre‐, intervention, and post‐groups. Demographics were similar between groups, except for age (P = .001) and influenza diagnoses (P < .001). Likelihood of receiving guideline compliant therapy at pre‐intervention (57%), intervention (69%), and post‐intervention (73%) showed substantial improvement (P < .001). Controlling for background variables, participants were almost two times more likely to receive guideline compliant therapy at intervention than at pre‐intervention (odds ratio [OR] = 1.96, P < .001). Conclusions An AS pharmacist's presence in an UC significantly increased compliance with antibiotic prescribing recommendations. The largest impact was in reducing antibiotic treatment of viral infections and optimizing antibiotic dosing.

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“…A descriptive pilot study conducted at our site of all 2016 data demonstrated that during the 1-year period 1,461 positive urgent care culture results were reviewed by clinical pharmacists for antimicrobial appropriateness. 17 Of these, 320 (22%) required pharmacist intervention in the form of a follow-up telephone call. Furthermore, 106 (33%) required a new antibiotic prescription at follow-up.…”

Section: Methodsmentioning

confidence: 99%

Pharmacist-led antimicrobial stewardship program in an urgent care setting

Fay

Wolf

Brandt

et al. 2019

American Journal of Health-System Pharmacy

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PurposeWhile many programs have demonstrated pharmacist-led antimicrobial stewardship successes in inpatient and emergency department (ED) settings, there is a paucity of literature exploring these initiatives in urgent care (UC) sites. This study aimed to determine the impact of implementing a pharmacist-led antimicrobial stewardship program (ASP) in the UC setting.MethodsA retrospective quasi-experimental study was conducted evaluating UC patients with positive urine or wound cultures following discharge. A collaborative practice agreement was implemented in 2015 allowing for pharmacist-led UC culture follow-up via a stewardship-focused protocol. The primary outcome of this study was to compare guideline-concordant antibiotic prescribing between the pre-ASP and post-ASP groups. Secondary outcomes included comparing the number of patients who required follow-up, time to follow-up, UC or ED revisits within 72 hours, and hospital admission within 30 days between groups.ResultsA total of 300 patients were included in the study (pre-ASP, n = 150; post-ASP, n = 150). Total guideline-concordant prescribing for all diagnoses was significantly improved in the post-ASP group (pre-ASP, 41.3% versus post-ASP 53.3%, p = 0.037). Additionally, guideline-concordant antibiotic selection improved in the post-ASP group (pre-ASP, 51% versus post-ASP, 68%, p = 0.01). Follow-up was required for 27 (18%) patients in the pre-ASP group compared with 16 (10.7%) in the post-ASP group (p = 0.07). Median time to follow-up call was longer in the post-ASP group (38 versus 71 hours, p < 0.001). There were no differences in UC and ED revisits within 72 hours (p = 1.0) or hospital admissions within 30 days (p = 0.723).ConclusionA pharmacist-led urgent care ASP was associated with significantly improved guideline-concordant antimicrobial prescribing.

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Expanding Antimicrobial Stewardship to Urgent Care Centers Through a Pharmacist-Led Culture Follow-up Program

Cited by 29 publications

References 10 publications

'Careful goodbye at the door': is there role for antimicrobial stewardship interventions for antimicrobial therapy prescribed on hospital discharge?

'Careful goodbye at the door': is there role for antimicrobial stewardship interventions for antimicrobial therapy prescribed on hospital discharge?

Evaluation of a pharmacist's impact on antimicrobial prescribing in an urgent care center

Pharmacist-led antimicrobial stewardship program in an urgent care setting

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