It’s about the patients: Practical antibiotic stewardship in outpatient settings in the United States

Amin, Alpesh; Dellinger, E. Patchen; Harnett, Glenn; Kraft, Bryan; LaPlante, Kerry L.; LoVecchio, Frank; McKinnell, James A.; Tillotson, Glenn; Valentine, Salisia

doi:10.3389/fmed.2022.901980

Cited by 4 publications

(1 citation statement)

References 79 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Yet, current LTCF AMS programmes usually target both nurses and physicians but fewer also target residents and/or their family [ 9 , 10 ]. Inspiration may be drawn from AMS strategies in primary care, where the importance of patients’ expectations is well recognised [ 88 , 89 ].…”

Section: Discussionmentioning

confidence: 99%

Resident-, prescriber-, and facility-level factors associated with antibiotic use in long-term care facilities: a systematic review of quantitative studies

Bocquier,

Erkilic,

Babinet

et al. 2024

Antimicrob Resist Infect Control

View full text Add to dashboard Cite

Background Antimicrobial stewardship programmes are needed in long-term care facilities (LTCFs) to tackle antimicrobial resistance. We aimed to identify factors associated with antibiotic use in LTCFs. Such information would be useful to guide antimicrobial stewardship programmes. Method We conducted a systematic review of studies retrieved from PubMed, Cochrane Library, Embase, APA PsycArticles, APA PsycINFO, APA PsycTherapy, ScienceDirect and Web of Science. We included quantitative studies that investigated factors associated with antibiotic use (i.e., antibiotic prescribing by health professionals, administration by LTCF staff, or use by residents). Participants were LTCF residents, their family, and/or carers. We performed a qualitative narrative synthesis of the findings. Results Of the 7,591 screened records, we included 57 articles. Most studies used a longitudinal design (n = 34/57), investigated resident-level (n = 29/57) and/or facility-level factors (n = 32/57), and fewer prescriber-level ones (n = 8/57). Studies included two types of outcome: overall volume of antibiotic prescriptions (n = 45/57), inappropriate antibiotic prescription (n = 10/57); two included both types. Resident-level factors associated with a higher volume of antibiotic prescriptions included comorbidities (5 out of 8 studies which investigated this factor found a statistically significant association), history of infection (n = 5/6), potential signs of infection (e.g., fever, n = 4/6), positive urine culture/dipstick results (n = 3/4), indwelling urinary catheter (n = 12/14), and resident/family request for antibiotics (n = 1/1). At the facility-level, the volume of antibiotic prescriptions was positively associated with staff turnover (n = 1/1) and prevalence of after-hours medical practitioner visits (n = 1/1), and negatively associated with LTCF hiring an on-site coordinating physician (n = 1/1). At the prescriber-level, higher antibiotic prescribing was associated with high prescription rate for antibiotics in the previous year (n = 1/1). Conclusions Improving infection prevention and control, and diagnostic practices as part of antimicrobial stewardship programmes remain critical steps to reduce antibiotic prescribing in LTCFs. Once results confirmed by further studies, implementing institutional changes to limit staff turnover, ensure the presence of a professional accountable for the antimicrobial stewardship activities, and improve collaboration between LTCFs and external prescribers may contribute to reduce antibiotic prescribing.

show abstract

Section: Discussionmentioning

confidence: 99%

Resident-, prescriber-, and facility-level factors associated with antibiotic use in long-term care facilities: a systematic review of quantitative studies

Bocquier,

Erkilic,

Babinet

et al. 2024

Antimicrob Resist Infect Control

View full text Add to dashboard Cite

show abstract

Navigating performance measures for ambulatory antimicrobial stewardship: a review of HEDIS® and other metrics the steward should know

Arena,

Veve,

Fried

et al. 2024

ASHE

View full text Add to dashboard Cite

Ambulatory antimicrobial stewardship can be challenging due to disparities in resource allocation across the care continuum, competing priorities for ambulatory prescribers, ineffective communication strategies, and lack of incentive to prioritize antimicrobial stewardship program (ASP) initiatives. Efforts to monitor and compare outpatient antibiotic usage metrics have been implemented through quality measures (QM). Healthcare Effectiveness Data and Information Set (HEDIS®) represent standardized measures that examine the quality of antibiotic prescribing by region and across insurance health plans. Health systems with affiliated emergency departments and ambulatory clinics contribute patient data for HEDIS measure assessment and are directly related to value-based reimbursement, pay-for-performance, patient satisfaction measures, and payor incentives and rewards. There are four HEDIS® measures related to optimal antibiotic prescribing in upper respiratory tract diseases that ambulatory ASPs can leverage to develop and measure effective interventions while maintaining buy-in from providers: avoidance of antibiotic treatment for acute bronchitis/bronchiolitis, appropriate treatment for upper respiratory infection, appropriate testing for pharyngitis, and antibiotic utilization for respiratory conditions. Additionally, there are other QM assessed by the Centers for Medicare and Medicaid Services (CMS), including overuse of antibiotics for adult sinusitis. Ambulatory ASPs with limited resources should leverage HEDIS® to implement and measure successful interventions due to their pay-for-performance nature. The purpose of this review is to outline the HEDIS® measures related to infectious diseases in ambulatory care settings. This review also examines the barriers and enablers in ambulatory ASPs which play a crucial role in promoting responsible antibiotic use and the efforts to optimize patient outcomes.

show abstract

New Agents Are Coming, and So Is the Resistance

Keck,

Viteri,

Schultz

et al. 2024

Antibiotics

View full text Add to dashboard Cite

Antimicrobial resistance is a global threat that requires urgent attention to slow the spread of resistant pathogens. The United States Centers for Disease Control and Prevention (CDC) has emphasized clinician-driven antimicrobial stewardship approaches including the reporting and proper documentation of antimicrobial usage and resistance. Additional efforts have targeted the development of new antimicrobial agents, but narrow profit margins have hindered manufacturers from investing in novel antimicrobials for clinical use and therefore the production of new antibiotics has decreased. In order to combat this, both antimicrobial drug discovery processes and healthcare reimbursement programs must be improved. Without action, this poses a high probability to culminate in a deadly post-antibiotic era. This review will highlight some of the global health challenges faced both today and in the future. Furthermore, the new Infectious Diseases Society of America (IDSA) guidelines for resistant Gram-negative pathogens will be discussed. This includes new antimicrobial agents which have gained or are likely to gain FDA approval. Emphasis will be placed on which human pathogens each of these agents cover, as well as how these new agents could be utilized in clinical practice.

show abstract

It’s about the patients: Practical antibiotic stewardship in outpatient settings in the United States

Cited by 4 publications

References 79 publications

Resident-, prescriber-, and facility-level factors associated with antibiotic use in long-term care facilities: a systematic review of quantitative studies

Resident-, prescriber-, and facility-level factors associated with antibiotic use in long-term care facilities: a systematic review of quantitative studies

Navigating performance measures for ambulatory antimicrobial stewardship: a review of HEDIS® and other metrics the steward should know

New Agents Are Coming, and So Is the Resistance

Contact Info

Product

Resources

About