Impact of ambulatory antimicrobial stewardship on prescribing patterns for urinary tract infections

Abstract

What is known and Objective Currently, there are limited data on ambulatory antimicrobial stewardship (AAMS) programmes in the primary care setting. The purpose of this study was to implement a pharmacist‐led AAMS programme for uncomplicated cystitis (UC) and pyelonephritis in a hospital‐based family medicine residency clinic. Methods A retrospective cohort study was used to assess clinician prescribing habits and identify areas of inappropriate prescribing. Females between 18 and 64 years old diagnosed with UC or pyelonephritis were included in the analysis. The primary objective was a composite of appropriate choice of antibiotic based on first‐line recommendations, appropriate dose and appropriate duration of therapy. The intervention included development of a guideline‐based antibiotic treatment summary accessible in the electronic health record (EHR), clinician education sessions for medical residents and faculty, and treatment defaults in the EHR. Results and Discussion Eighty‐one patients were included in the pre‐intervention group and 81 in the post‐intervention group. In the pre‐intervention group, 37% of patients met the composite primary outcome vs. 71.6% in the post‐intervention group (P < .001) for UC and pyelonephritis combined. This was primarily driven by improvement in appropriate duration of therapy for both diagnoses which increased from 44.4% to 84.0% (P < .001). What is new and Conclusions A pharmacist‐led AAMS programme significantly improved guideline‐based treatment adherence for UC and pyelonephritis based on the composite of appropriate choice of antibiotic, appropriate dose and appropriate duration of therapy in a primary care family medicine setting.

Outcomes of an ambulatory care pharmacist-led antimicrobial stewardship program within a family medicine resident clinic

“…[7][8][9][10][11][12] Furthermore, few efforts have targeted medical residents, an important target for ASPs in establishing good habits for antibiotic prescribing. [13][14][15] Although infectious diseases (ID) practitioners typically serve as ASP leaders in inpatient settings, this resource may be scarce in the outpatient setting. Ambulatory care pharmacists (AMCPs) working within primary-care practice sites may serve a critical role as stewardship collaborators and leaders in the outpatient setting; they have established relationships with the provider team and skills needed to identify problematic trends in antimicrobial use and to provide active intervention.…”

From concept to reality: Building an ambulatory antimicrobial stewardship program

“…The content of education provided is also likely to vary depending on the annual ASP goals selected, audience, delivery method, and duration; however, specific attention should be given to the provision of education highlighting the background, data, and specifics of the established organizational ASP goal and intended strategies to improve antimicrobial prescribing 5,7 . In the absence of more active intervention strategies as outlined above, isolated educational interventions are unlikely to contribute to sustained change in prescribing practices, thus many interventions that have shown an improvement in guideline‐concordant prescribing have utilized a multimodal interventional approach 17,22‐28 …”

Impact of order sentence implementation on outpatient antibiotic prescribing for urinary tract infection and skin and soft tissue infection

“…These new requirements mirror successful inpatient antimicrobial stewardship elements and provide a framework for the annual components ambulatory sites should include in their outpatient ASP to be successful. Outpatient ASPs involving pharmacist‐led audit‐and‐feedback have been described in the literature and have been successful in optimizing antibiotic prescribing for common infectious diseases 5‐9 . Although effective, this strategy is resource‐intensive, requiring dedicated time from ambulatory care or infectious diseases pharmacists to provide education and conduct audit‐and‐feedback; therefore, such a strategy may not be feasible in all ambulatory sites with limited resources for antimicrobial stewardship.…”

“…Outpatient ASPs involving pharmacist-led audit-and-feedback have been described in the literature and have been successful in optimizing antibiotic prescribing for common infectious diseases. [5][6][7][8][9] Although effective, this strategy is resource-intensive, requiring dedicated time from ambulatory care or infectious diseases pharmacists to provide education and conduct audit-and-feedback; therefore, such a strategy may not be feasible in all ambulatory sites with limited resources for antimicrobial stewardship. Due to this limitation, methods other than manual audit-and-feedback must be explored to optimize antibiotic prescribing with limited resources.…”