Novel outpatient antibiotic prescribing report of respiratory infections in a pediatric health system's emergency departments and urgent care clinics

Feghaly, Rana E. El; Burns, Alaina; Goldman, Jennifer L.; Myers, Angela; Purandare, Amol; Lee, Brian

doi:10.1016/j.ajic.2020.08.023

Cited by 11 publications

(10 citation statements)

References 9 publications

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“…Our results demonstrate the potential of the EHR for reducing the workload of ASPs. While some electronically based metrics (eg, overall prescribing rates) are used to track aggregate antibiotic use, they are at best surrogate markers of inappropriate antibiotic use [ 17 ]. Therefore, ASP initiatives must utilize time-intensive strategies (eg, medication use evaluations) to qualitatively assess appropriateness of antibiotic use [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Development of an Electronic Algorithm to Target Outpatient Antimicrobial Stewardship Efforts for Acute Bronchitis and Pharyngitis

Lautenbach

Hamilton

Grundmeier

et al. 2022

Open Forum Infectious Diseases

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Background A major challenge for antibiotic stewardship programs is lack of accurate and accessible electronic data to target interventions. We developed and validated separate electronic algorithms to identify inappropriate antibiotic use for adult outpatients with bronchitis and pharyngitis. Methods We used ICD-10 diagnostic codes to identify patient encounters for acute bronchitis and pharyngitis at outpatient practices between 3/15/17–3/14/18. Exclusion criteria included immunocompromising conditions, complex chronic conditions, and concurrent infections. We randomly selected 300 eligible subjects each with bronchitis and pharyngitis. Inappropriate antibiotic use based on chart review served as the gold standard for assessment of the electronic algorithm, which was constructed using only data in the electronic data warehouse. Criteria for appropriate prescribing, choice of antibiotic, and duration were based on established guidelines. Results Of 300 subjects with bronchitis, 167 (55.7%) received an antibiotic inappropriately based on chart review. The electronic algorithm demonstrated 100% sensitivity and 95.3% specificity for detection of inappropriate prescribing. Of 300 subjects with pharyngitis, 94 (31.3%) had an incorrect prescribing decision. Among 29 subjects with a positive rapid streptococcal antigen test, 27 (93.1%) received an appropriate antibiotic and 29 (100%) received the correct duration. The electronic algorithm demonstrated very high sensitivity and specificity for all outcomes. Conclusions Inappropriate antibiotic prescribing for bronchitis and pharyngitis is common. Electronic algorithms for identifying inappropriate prescribing, antibiotic choice, and duration showed excellent test characteristics. These algorithms could be used to efficiently assess prescribing among practices and individual clinicians. Interventions based on these algorithms should be tested in future work.

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Section: Discussionmentioning

confidence: 99%

Development of an Electronic Algorithm to Target Outpatient Antimicrobial Stewardship Efforts for Acute Bronchitis and Pharyngitis

Lautenbach

Hamilton

Grundmeier

et al. 2022

Open Forum Infectious Diseases

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“…2,7 Existing studies describing the appropriateness of antibiotic prescribing to children are limited to larger databases of all ages 2,10,22 and/or specific outpatient settings within an organization. [23][24][25] Medicaid children have been identified as an important target for antibiotic stewardship due to higher rates of parental misconceptions and higher impact of interventions. 26,27 Use of this antibiotic appropriateness classification scheme with state-level claims data identifies important targets for outpatient stewardship interventions.…”

Section: Discussionmentioning

confidence: 99%

Inappropriate outpatient antibiotic use in children insured by Kentucky Medicaid

Wattles

Jawad

Feygin

et al. 2021

Infect. Control Hosp. Epidemiol.

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Objective: To describe risk factors associated with inappropriate antibiotic prescribing to children. Design: Cross-sectional, retrospective analysis of antibiotic prescribing to children, using Kentucky Medicaid medical and pharmacy claims data, 2017. Participants: Population-based sample of pediatric Medicaid patients and providers. Methods: Antibiotic prescriptions were identified from pharmacy claims and used to describe patient and provider characteristics. Associated medical claims were identified and linked to assign diagnoses. An existing classification scheme was applied to determine appropriateness of antibiotic prescriptions. Results: Overall, 10,787 providers wrote 779,813 antibiotic prescriptions for 328,515 children insured by Kentucky Medicaid in 2017. Moreover, 154,546 (19.8%) of these antibiotic prescriptions were appropriate, 358,026 (45.9%) were potentially appropriate, 163,654 (21.0%) were inappropriate, and 103,587 (13.3%) were not associated with a diagnosis. Half of all providers wrote 12 prescriptions or less to Medicaid children. The following child characteristics were associated with inappropriate antibiotic prescribing: residence in a rural area (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.07–1.1), having a visit with an inappropriate prescriber (OR, 4.15; 95% CI, 4.1–4.2), age 0–2 years (OR, 1.39; 95% CI, 1.37–1.41), and presence of a chronic condition (OR, 1.31; 95% CI, 1.28–1.33). Conclusions: Inappropriate antibiotic prescribing to Kentucky Medicaid children is common. Provider and patient characteristics associated with inappropriate prescribing differ from those associated with higher volume. Claims data are useful to describe inappropriate use and could be a valuable metric for provider feedback reports. Policies are needed to support analysis and dissemination of antibiotic prescribing reports and should include all provider types and geographic areas.

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“…Although essential for inpatient ASP work, data analysis is crucial for a successful outpatient ASP in which real-time audit and feedback is often difficult and interventions are often driven by antibiotic use reports. 33 Interestingly, 15% of programs provide education to nurses which is part of the Core Elements and often absent from inpatient stewardship.…”

Section: Discussionmentioning

confidence: 99%

Outpatient antimicrobial stewardship programs in pediatric institutions in 2020: Status, needs, barriers

Feghaly

Monsees

Burns

et al. 2021

Infect. Control Hosp. Epidemiol.

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Objective: To assess current resources, interventions, and obstacles of pediatric outpatient antimicrobial stewardship programs (ASP). Design: Cross-sectional study. Setting: Institutions from the Sharing Antimicrobial Reports for Pediatric Stewardship OutPatient collaborative (SHARPS-OP). Participants: Antimicrobial stewardship leaders from the above institutions. Methods: An investigator-developed survey was deployed online in September 2020 to antimicrobial stewardship leaders in SHARPS-OP institutions. The survey was divided into 4 sections: (1) basic information, (2) status of pediatric outpatient ASP in the institutions including financial support, (3) outpatient ASP interventions undertaken by the institutions, and (4) needs and SHARPS-OP collaborative goals. Results: Of 56 invited institutions, 45 participated, achieving an 80% response rate. Only 5 sites (11%) had allocated financial support for an outpatient ASP, compared to 42 (95.6%) for their inpatient ASP. The most widely used outpatient ASP interventions included antimicrobial guidance (57.8%), education (46.7%), and quality improvement projects (37.8%). Time was identified as the biggest barrier to expanding outpatient ASPs (91.1%), followed by financial support (53.3%), development of meaningful reports (51.1%), and administrative support (44.4%). Important goals of the collaborative included seeking learning opportunities and developing clear metrics for pediatric outpatient ASP benchmarking. Program needs included securing operational support (35.8%) and strengthening data analysis (31.6%). Conclusions: Very few pediatric institutions with robust inpatient ASPs have devoted time and financial support to advance outpatient efforts. To promote appropriate antibiotic prescribing in the outpatient arena, time and resource funding by administrative leaders are necessary to develop a robust, sustainable stewardship infrastructure.

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Novel outpatient antibiotic prescribing report of respiratory infections in a pediatric health system's emergency departments and urgent care clinics

Cited by 11 publications

References 9 publications

Development of an Electronic Algorithm to Target Outpatient Antimicrobial Stewardship Efforts for Acute Bronchitis and Pharyngitis

Development of an Electronic Algorithm to Target Outpatient Antimicrobial Stewardship Efforts for Acute Bronchitis and Pharyngitis

Inappropriate outpatient antibiotic use in children insured by Kentucky Medicaid

Outpatient antimicrobial stewardship programs in pediatric institutions in 2020: Status, needs, barriers

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