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

Abstract

Objective: To determine whether an ambulatory care pharmacist (AMCP)-led intervention improved outpatient antibiotic prescribing in a family medicine residency clinic (FMRC) for upper respiratory tract infections (URIs), urinary tract infections (UTIs), and skin and soft-tissue infections (SSTIs). Design: Retrospective, quasi-experimental study comparing guideline-concordant antibiotic prescribing before and after an antimicrobial stewardship program (ASP) intervention. Setting: Family medicine residency clinic affiliated with a community teaching hospital. Participants: Adult and pediatric patients prescribed antibiotics for URI, UTI, or SSTI between November 1, 2017, and April 31, 2018 (pre-ASP group), or October 1, 2018, and March 31, 2019 (ASP group), were eligible for inclusion. Methods: The health-system ASP physician and pharmacist provided live education and pocket cards to FMRC staff with local guidelines as a quick reference. Audit with feedback was delivered every other week by the clinic’s AMCP. Guideline-concordance was determined based on the institution’s outpatient ASP guidelines. Results: Overall, 525 antibiotic prescriptions were audited (pre-ASP n = 90 and ASP n = 435). Total guideline-concordant antibiotic prescribing at baseline was 38.9% (URI, 53.3%; SSTI, 16.7%; UTI, 46.7%) and improved across all 3 infection types to 57.9% (URI, 61.2%; SSTI, 57.6%; UTI, 53.5%; P = .001). Significant improvements were seen in guideline-concordant antibiotic selection (68.9% vs 80.2%; P = .018), dose (76.7% vs 86.2%; P = .023), and duration of therapy (73.3% vs 86.2%; P = .02). Conclusions: An AMCP-led outpatient ASP intervention significantly improved guideline-concordant antibiotic prescribing for common infections within a FMRC.

Understanding of Pharmacy Students towards Antibiotic Use, Antibiotic Resistance and Antibiotic Stewardship Programs: A Cross-Sectional Study from Punjab, Pakistan

“…The role of pharmacists in medicine use, including managing ABR through antibiotic stewardship programs (programs that work in collaboration with healthcare professionals aiming to improve patient outcomes by minimizing antibiotic resistance, therapy cost, and risk of resistant infections), is manifested in previously published research [ 12 , 13 , 14 ]. Education and adequate pharmacists’ training could modify the behavior of doctors, nurses, and consumers as they are the most accessible professionals in the community [ 13 , 15 ].…”

“…The role of pharmacists in medicine use, including managing ABR through antibiotic stewardship programs (programs that work in collaboration with healthcare professionals aiming to improve patient outcomes by minimizing antibiotic resistance, therapy cost, and risk of resistant infections), is manifested in previously published research [ 12 , 13 , 14 ]. Education and adequate pharmacists’ training could modify the behavior of doctors, nurses, and consumers as they are the most accessible professionals in the community [ 13 , 15 ]. The professional practice of pharmacists could become substandard in some developing countries, including Pakistan, China, and India if they have insufficient training and education; as a consequence, pharmacists may recommend and supply antibiotics inappropriately [ 16 , 17 ].…”

A Baker’s Dozen of Top Antimicrobial Stewardship Intervention Publications in 2020

“…Education alone may be an insufficient AS strategy in this setting [ 36 ]. Westerhof and colleagues evaluated the impact of a multifaceted, outpatient ASP led by 2 ambulatory care pharmacists (AMCPs) on prescribing practices for upper respiratory infections (URIs), urinary tract infections (UTIs), and skin and soft tissue infections at a family medicine resident clinic [ 17 ]. The study evaluated the effect of a 3-pronged ASP intervention on the rate of prescribing concordance with local guidelines.…”

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 …”

“…Educational intervention was done in concert with dissemination of pocket cards containing local clinical guidelines outlining appropriate antimicrobial prescribing in URI, UTI, and SSTI. Educational efforts were reinforced with subsequent pharmacist‐provided retrospective audit and feedback (indication, antimicrobial selection, dose, and duration) delivered bimonthly 28 . Secondary to implementation of this multifaceted approach, guideline concordant antibiotic prescribing (ie, all facets of prescribing) for URI, UTI, and SSTI improved from 38.9% to 57.9% ( P = .001), with improvement demonstrated in each of the evaluated infectious syndromes.…”