Providers' knowledge and perceptions regarding antibiotic stewardship and antibiotic prescribing in rural primary care clinics

2020 ◽  
Vol 3 (3) ◽  
pp. 601-608
Author(s):  
Wesley D. Kufel ◽  
Keri A. Mastro ◽  
Bryan T. Mogle ◽  
Karen S. Williams ◽  
James Jester ◽  
...  
Keyword(s):  
Primary Care ◽  
Antibiotic Stewardship ◽  
Antibiotic Prescribing ◽  
Primary Care Clinics ◽  
Rural Primary Care

scholarly journals Inappropriate Azithromycin Use in Nine Primary-Care Clinics Before and After Implementation of Provider Guidance in the EMR

2020 ◽  
Vol 41 (S1) ◽  
pp. s292-s293
Author(s):  
Alexandria May ◽  
Allison Hester ◽  
Kristi Quairoli ◽  
Sheetal Kandiah
Keyword(s):  
Primary Care ◽  
Retrospective Chart Review ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
National Guidelines ◽  
Targeted Interventions ◽  
Primary Care Clinics ◽  
Before And After ◽  
Upper Respiratory ◽  
Tract Infections

Background: According to the CDC Core Elements of Outpatient Stewardship, the first step in optimizing outpatient antibiotic use the identification of high-priority conditions in which antibiotics are commonly used inappropriately. Azithromycin is a broad-spectrum antimicrobial commonly used inappropriately in clinical practice for nonspecific upper respiratory infections (URIs). In 2017, a medication use evaluation at Grady Health System (GHS) revealed that 81.4% of outpatient azithromycin prescriptions were inappropriate. In an attempt to optimize outpatient azithromycin prescribing at GHS, a tool was designed to direct the prescriber toward evidence-based therapy; it was implemented in the electronic medical record (EMR) in January 2019. Objective: We evaluated the effect of this tool on the rate of inappropriate azithromycin prescribing, with the goal of identifying where interventions to improve prescribing are most needed and to measure progress. Methods: This retrospective chart review of adult patients prescribed oral azithromycin was conducted in 9 primary care clinics at GHS between February 1, 2019, and April 30, 2019, to compare data with that already collected over a 6-month period in 2017 before implementation of the antibiotic prescribing guidance tool. The primary outcome of this study was the change in the rate of inappropriate azithromycin prescribing before and after guidance tool implementation. Appropriateness was based on GHS internal guidelines and national guidelines. Inappropriate prescriptions were classified as inappropriate indication, unnecessary prescription, excessive or insufficient treatment duration, and/or incorrect drug. Results: Of the 560 azithromycin prescriptions identified during the study period, 263 prescriptions were included in the analysis. Overall, 181 (68.8%) of azithromycin prescriptions were considered inappropriate, representing a 12.4% reduction in the primary composite outcome of inappropriate azithromycin prescriptions. Bronchitis and unspecified upper respiratory tract infections (URI) were the most common indications where azithromycin was considered inappropriate. Attending physicians prescribed more inappropriate azithromycin prescriptions (78.1%) than resident physicians (37.0%) or midlevel providers (37.0%). Also, 76% of azithromycin prescriptions from nonacademic clinics were considered inappropriate, compared with 46% from academic clinics. Conclusions: Implementation of a provider guidance tool in the EMR lead to a reduction in the percentage of inappropriate outpatient azithromycin prescriptions. Future targeted interventions and stewardship initiatives are needed to achieve the stewardship program’s goal of reducing inappropriate outpatient azithromycin prescriptions by 20% by 1 year after implementation.Funding: NoneDisclosures: None

scholarly journals Medical students' assessments of skill development in rural primary care clinics

2006 ◽  
Author(s):  
Matthew Hunsaker ◽  
Michael Glasser ◽  
Kim Nielsen ◽  
martin lipsky
Keyword(s):  
Primary Care ◽  
Medical Students ◽  
Skill Development ◽  
Primary Care Clinics ◽  
Rural Primary Care

scholarly journals An antibiotic stewardship programme to reduce inappropriate antibiotic prescribing for acute respiratory infections in rural Chinese primary care facilities: study protocol for a clustered randomised controlled trial

2020 ◽  
Author(s):  
Chao Zhuo ◽  
Xiaolin Wei ◽  
Zhitong Zhang ◽  
Joseph Paul Hicks ◽  
Jinkun Zheng ◽  
...  
Keyword(s):  
Primary Care ◽  
Antibiotic Stewardship ◽  
Respiratory Infections ◽  
Inappropriate Prescribing ◽  
Antibiotic Prescribing ◽  
Acute Respiratory Infections ◽  
Care Facilities ◽  
Randomised Controlled ◽  
Antibiotic Stewardship Programme

Abstract Background: Inappropriate prescribing of antibiotics for acute respiratory infections at primary care level represents the major source of antibiotic misuse in healthcare, and is a major driver for antimicrobial resistance worldwide. In this study we will develop, pilot and evaluate the effectiveness of a comprehensive antibiotic stewardship programme in China’s primary care hospitals to reduce inappropriate prescribing of antibiotics for acute respiratory infections among all ages.Methods: We will use a parallel-group, cluster-randomised, controlled, superiority trial with blinded outcome evaluation but unblinded treatment (providers and patients). We will randomise 34 primary care hospitals from two counties within Guangdong province into the intervention and control arm (1:1 overall ratio) stratified by county (8:9 within-county ratio). In the control arm, antibiotic prescribing and management will continue through usual care. In the intervention arm, we will implement an antibiotic stewardship programme targeting family physicians and patients/caregivers. The family physician components include: 1) training using new operational guidelines, 2) improved management and peer-review of antibiotic prescribing, 3) improved electronic medical records and smart phone app facilitation. The patient/caregiver component involves patient education via family physicians, leaflets and videos. The primary outcome is the proportion of prescriptions for acute respiratory infections (excluding pneumonia) that contain any antibiotic(s). Secondary outcomes will address how frequently specific classes of antibiotics are prescribed, how frequently key non-antibiotic alternatives are prescribed and the costs of consultations. We will conduct a qualitative process evaluation to explore operational questions regarding acceptability, cultural appropriateness and burden of technology use, as well as a cost-effectiveness analysis and a long-term benefit evaluation. The duration of the intervention will be 12 months, with another 24 months post-trial long-term follow-up.Discussion: Our study is one of the first trials to evaluate the effect of an antibiotic stewardship programme in primary care settings in a low- or middle-income country (LMIC). All intervention activities will be designed to be embedded into routine primary care with strong local ownership. Through the trial we intend to impact on clinical practice and national policy in antibiotic prescription for primary care facilities in rural China and other LMICs.Trial registration: ISRCTN, ISRCTN96892547. Registered 18 August 2019, http://www.isrctn.com/ISRCTN96892547

scholarly journals Recruitment of Men Into a Pragmatic Rural Primary Care Weight Loss Trial

2020 ◽  
Vol 14 (6) ◽  
pp. 155798832097191
Author(s):  
Stephanie E. Punt ◽  
Daniel L. Kurz ◽  
Christie A. Befort
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Response Rate ◽  
Behavioral Weight Loss ◽  
Men And Women ◽  
Primary Care Clinics ◽  
Rural Primary Care ◽  
Lower Response Rate ◽  
Enrollment Rates ◽  
Mixed Gender

Men remain underrepresented in behavioral weight loss trials and are more difficult to recruit compared to women. We describe recruitment response of men and women into a mixed-gender behavioral weight loss trial conducted within 36 rural primary care clinics. Participants were recruited through primary care clinics via direct mailings ( n = 15,076) and in-clinic referrals by their primary care provider (PCP). Gender differences were examined in response rate to direct mailings, study referral source, and rates of proceeding to study screening, being eligible, and enrolling. Men had a lower response rate to direct mailings than women (7.8% vs. 17.7%, p < .001). Men (vs. women) responding to the mailing were more likely to respond by opt-in postcard (64.6% vs. 56.8%) and less likely to respond by phone (33.9% vs. 39.6%), p = .002. Among potential participants contacting the study ( n = 2413), men were less likely to report being referred by PCPs (15.2% vs. 21.6%; p < .001), but were just as likely to proceed to screening, be eligible, and enroll. Men and women were more likely to proceed to screening when referred by PCPs (93.3% vs. 95.4%) compared to direct mailings (74.2% vs. 73.9%). Enrolled men were older ( p < .001), more likely to be married ( p = .04), and had higher levels of education ( p = .01). Men were less likely than women to respond to direct mailings and to be referred by their PCP, but after contacting the study, had similar screening, eligibility, and enrollment rates. Encouraging and training providers to refer men during clinic visits may help recruit more men into primary care-based weight loss trials.

scholarly journals A GWEP COLLABORATION: IMPLEMENTING THE AWV IN A RURAL PRIMARY CARE CLINIC

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S393-S393
Author(s):  
Christine McKibbin
Keyword(s):  
Primary Care ◽  
Patient Outcomes ◽  
Primary Care Clinic ◽  
Lessons Learned ◽  
Care Clinic ◽  
Primary Care Clinics ◽  
Rural Primary Care

Abstract This presentation will focus on the collaboration with the Dartmouth GWEP to implement the AWV in a rural primary care clinic. The challenges of practice transformation in busy primary care clinics will be discussed along with lessons learned on a successful GWEP partnership to achieve improved patient outcomes in primary care.

scholarly journals SPREAD AND SUSTAINMENT OF QUALITY IMPROVEMENTS IN VA RURAL PRIMARY CARE CLINICS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S756-S756
Author(s):  
Josea Kramer ◽  
Claire O’Hanlon ◽  
Joe Douglas ◽  
Michael N Mitchell ◽  
Michael McClean ◽  
...  
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Potentially Inappropriate Medications ◽  
Quality Improvements ◽  
Primary Care Clinics ◽  
Rural Primary Care ◽  
Rural And Urban ◽  
Primary Care Workforce

Abstract The VA has invested in developing the skills of its primary care workforce through the longitudinal Geriatric Scholars Program. Now in its 11th year, the program has increased career satisfaction and job retention, standardized provider behaviors, improved clinical decision-making and reduced dispensing of potentially inappropriate medications. The program consists of: intensive coursework in geriatrics; workshop in quality improvement (QI); and initiation of a micro QI projects in the Scholar’s clinic. Electives enable learners to tailor the program to self-identified gaps in knowledge, skills and competencies. This presentation focuses on the sustainment and spread of these QI projects based on a recent survey of Scholars. Differences between rural and urban QI projects are compared. Commonality among rural QI projects is explored based on topic, team composition, and the types of efficiencies gained in clinical and/or organizational processes to improve care for older Veterans living in rural areas.

Providing Diabetes Self-Management Support in Rural Primary Care Clinics With Nurse Partners

2012 ◽  
Vol 34 (8) ◽  
pp. 1023-1042 ◽  
Author(s):  
Molly Vetter-Smith ◽  
Joseph LeMaster ◽  
Joshua Olsberg ◽  
Robin Kruse ◽  
Tamara Day ◽  
...  
Keyword(s):  
Primary Care ◽  
Self Management ◽  
Management Support ◽  
Primary Care Clinics ◽  
Rural Primary Care

scholarly journals Primary Care Physicians’ Attitudes and Perceptions Towards Antibiotic Resistance and Antibiotic Stewardship: A National Survey

2020 ◽  
Vol 7 (7) ◽  
Author(s):  
Rachel M Zetts ◽  
Andrea M Garcia ◽  
Jason N Doctor ◽  
Jeffrey S Gerber ◽  
Jeffrey A Linder ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Antibiotic Resistance ◽  
Antibiotic Stewardship ◽  
Primary Care Physicians ◽  
Inappropriate Prescribing ◽  
The United States ◽  
Vaccine Hesitancy ◽  
Resistant Bacteria ◽  
Antibiotic Prescribing

Abstract Background Outpatient antibiotic stewardship is needed to reduce inappropriate prescribing and minimize the development of resistant bacteria. We assessed primary care physicians’ perceptions of antibiotic resistance, antibiotic use, and the need for stewardship activities. Methods We conducted a national online survey of 1550 internal, family, and pediatric medicine physicians in the United States recruited from an opt-in panel of healthcare professionals. Descriptive statistics were generated for respondent demographics and question responses. Responses were also stratified by geographic region and medical specialty, with a χ 2 test used to assess for differences. Results More respondents agreed that antibiotic resistance was a problem in the United States (94%) than in their practice (55%) and that inappropriate antibiotic prescribing was a problem in outpatient settings (91%) than in their practice (37%). In addition, 60% agreed that they prescribed antibiotics more appropriately than their peers. Most respondents (91%) believed that antibiotic stewardship was appropriate in office-based practices, but they ranked antibiotic resistance as less important than other public health issues such as obesity, diabetes, opioids, smoking, and vaccine hesitancy. Approximately half (47%) believed they would need a lot of help to implement stewardship. Respondents indicated that they were likely to implement antibiotic stewardship efforts in response to feedback or incentives provided by payers or health departments. Conclusions Primary care physicians generally did not recognize antibiotic resistance and inappropriate prescribing as issues in their practice. This poses a challenge for the success of outpatient stewardship. Healthcare stakeholders will need to explore opportunities for feedback and incentive activities to encourage stewardship uptake.

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