2020
DOI: 10.1093/cid/ciaa1831
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Impact of Implementation of the Core Elements of Outpatient Antibiotic Stewardship Within Veterans Health Administration Emergency Departments and Primary Care Clinics on Antibiotic Prescribing and Patient Outcomes

Abstract: Background The Core Elements of Outpatient Antibiotic Stewardship provide a framework to improve antibiotic use, but evidence supporting safety are limited. We report the impact of Core Elements implementation within Veterans Health Administration sites. Methods A quasi-experimental controlled study assessed the effects of an intervention targeting antibiotic prescription for uncomplicated acute respiratory tract infections (… Show more

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Cited by 28 publications
(33 citation statements)
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“…7 We suspect that these changes reflect more appropriate diagnostic coding resulting from education, as suggested by others. 29,30 Total antibiotic prescribing changed little after the intervention, as expected, since we did not focus on prescribing reduction but rather on guideline-concordant care. The reduction in use with improved URI performance likely represented a small proportion of total antibiotic use.…”
Section: Discussionmentioning
confidence: 71%
“…7 We suspect that these changes reflect more appropriate diagnostic coding resulting from education, as suggested by others. 29,30 Total antibiotic prescribing changed little after the intervention, as expected, since we did not focus on prescribing reduction but rather on guideline-concordant care. The reduction in use with improved URI performance likely represented a small proportion of total antibiotic use.…”
Section: Discussionmentioning
confidence: 71%
“…Potential infectious complications (ie, Clostridioides difficile infections, pneumonia, meningitis, mastoiditis, or facial cellulitis) were identified by a new outpatient or inpatient diagnostic code for these conditions within 30 days following the index visit (eTable S7). [9][10][11] Return visits for gastrointestinal-related adverse antibiotic events were identified by outpatient visits or inpatient admissions with diagnostic codes consistent with potential gastrointestinal-related adverse antibiotic events (ie, diarrhea, colitis, hepatitis, nausea) for visits that occurred within 14 days after the index acute sinusitis visit if the patient did not have a similar diagnostic code within 6 months preceding the visit (eTable S7). 10 Hospitalizations were defined by an admission date that occurred between 1 and 30 days following the index visit.…”
Section: Discussionmentioning
confidence: 99%
“…In addition, the ICD-based measurement of gastrointestinal-related adverse events had limited sensitivity and specificity to identify true antibiotic adverse events. 10 Conservatively, application of the findings should be limited to episodes of uncomplicated acute sinusitis in primarily elderly adult males without recent antibiotic exposures.…”
Section: Limitationsmentioning
confidence: 99%
“…This increased to 85% in 2018 [ 97 ]. After implementation of the core elements, the CDI incidence and antimicrobial use decreased [ 98 99 ].…”
Section: Recommended Guidelines For Each Key Questionmentioning
confidence: 99%