Improving antibiotic prescribing for acute bronchitis in the ambulatory setting using a multifaceted approach

Abstract

Antibiotics are frequently prescribed inappropriately for acute respiratory infections in the outpatient setting. We report the implementation of a multifaceted outpatient antimicrobial stewardship initiative resulting in a 12.3% absolute reduction of antibiotic prescribing for acute bronchitis in primary care clinics receiving active interventions.

A multimodal intervention to decrease inappropriate outpatient antibiotic prescribing for upper respiratory tract infections in a large integrated healthcare system

“…Our overall reduction in antibiotic prescribing compares favorably to results published on similar interventions in outpatient prescribing ranging from 4.8% to 23%. 8,11,28 Previous studies have evaluated educational interventions, EHR-based interventions, or evaluation of peer-to-peer feedback individually. [8][9][10][29][30][31][32][33][34] In a recent Canadian trial, sending a single peer-comparison letter to primary-care physicians in the highest quartile of antibiotic prescribers decreased overall prescribing and prolonged-duration prescribing.…”

“…8,11,28 Previous studies have evaluated educational interventions, EHR-based interventions, or evaluation of peer-to-peer feedback individually. [8][9][10][29][30][31][32][33][34] In a recent Canadian trial, sending a single peer-comparison letter to primary-care physicians in the highest quartile of antibiotic prescribers decreased overall prescribing and prolonged-duration prescribing. 28 Those letters contained recommendations and education, signed by medical leaders.…”

“…Furthermore, previously published studies of outpatient antimicrobial stewardship have focused on specific practice settings or provider types and on effectiveness of different individual intervention strategies like electronic health record (EHR) alerts, provider education, or provider data feedback. [5][6][7][8][9][10] Few studies to date have examined how to best integrate all of these features with ongoing measurement of prescribing rates within the context of a larger, multiple-specialty, integrated healthcare network (where most provider groups now function). [10][11][12][13] In the Carolinas Healthcare Outpatient Antimicrobial Stewardship Empowerment Network (CHOSEN) program, we applied a stakeholder-centered design to develop and implement a bundle of key intervention strategies in diverse ambulatory practices within a large integrated network, including (1) patient and provider education tailored to practice-specific needs and (2) easily accessible, timely data on prescribing patterns for providers and practice managers to track and compare antimicrobial prescribing rates.…”

Inclusion, diversity, access, and equity in antimicrobial stewardship: where we are and where we are headed

“…Notwithstanding limited guidance to specifically address antimicrobial prescribing disparities, there is some evidence regarding effective practices aimed at reducing overall antimicrobial overprescribing [57][58][59]. Some of the most successful interventions have been those informed by behavioral science, such as feedback with peer comparison and accountable justification [58].…”

Antibiotic Prescribing for Acute Respiratory Illnesses in Persons With HIV Compared With Persons Without HIV

“…In another study, almost 50% of all ambulatory visits designated for acute respiratory infections (ARIs) resulted in an antibiotic prescription, and up to 30% of prescriptions were unnecessary [ 3 ]. Data from our own institution showed that outpatient prescribing for acute bronchitis (a diagnosis that almost never requires an antibiotic) varied considerably between clinics, from 40.8% to 74.5%, with a mean of 53.7% [ 4 ].…”