scholarly journals Novel Method to Evaluate Diagnostic Shifting After a Pediatric Antibiotic Stewardship Intervention

2020 ◽  
Vol 41 (S1) ◽  
pp. s332-s333
Author(s):  
Nora Fino ◽  
Benjamin Haaland ◽  
Karl Madaras-Kelly ◽  
Katherine Fleming-Dutra ◽  
Adam Hersh ◽  
...  
Keyword(s):  
Respiratory Infections ◽  
Population Attributable Fraction ◽  
Acute Otitis Media ◽  
Population Level ◽  
Estimating Equation ◽  
Audit And Feedback ◽  
Antibiotic Prescribing ◽  
Post Intervention ◽  
Intervention Effect ◽  
Diagnostic Coding

Background: Audit-and-feedback interventions track clinician practice patterns for a targeted practice behavior. Audit and feedback of antibiotic prescribing data for acute respiratory infections (ARI) is an effective stewardship strategy that relies on administrative coding to identify eligible visits for audit. Diagnostic shifting is the misclassification of a patient’s diagnosis in response to audit and feedback and is a potential unintended consequence of audit and feedback. Objective: To develop a method to identify patterns consistent with diagnostic shifting including both positive shifting (improved diagnosis and documentation) and negative shifting (intentionally altering documentation of diagnosis to justify antibiotic prescribing), after implementation of an audit-and-feedback intervention to improve ARI management. Methods: We evaluated the intervention effect on diagnostic shifting within 12 University of Utah pediatric clinics (293 providers). Data included 66,827 ARI diagnoses: pneumonia, sinusitis, bronchitis, pharyngitis, upper respiratory infection (URI), acute otitis media (AOM), or serous otitis with effusion (OME). To determine whether rates of ARI diagnoses changed after the intervention, we developed logistic generalized estimating equation (GEE) models with robust sandwich standard error estimates to account for clinic-wise clustering. Outcomes included the change in each ARI diagnosis relative to the competing 6 diagnoses included in audit-and-feedback reports before and after intervention implementation. Models tested for a change in outcomes after the intervention (ie, diagnostic shift) after adjustment for month of diagnosis. For each diagnosis, we estimated the population attributable fraction (PAF) for antibiotic prescriptions due to combined shifts in diagnostic frequencies and prescription rates for each diagnosis. The PAF is the estimated fraction of antibiotic prescriptions that would have changed under a population-level intervention. Results: In month-adjusted analyses, diagnoses of pneumonia and OME decreased after the intervention: odds ratio (OR), 0.46 (95% CI, 0.31–0.68) and OR, 0.81 (95% CI, 0.67–0.99), respectively. In addition, URI diagnoses increased: OR, 1.05 (95% CI 1.00, 1.11). We did not detect changes in the diagnosis rates of sinusitis, AOM, bronchitis, and pharyngitis post intervention. The intervention effect on the PAF for antibiotics prescriptions was consistently positive but relatively small in magnitude. PAF was highest for URIs (PAF, 8.87%), followed by AOM (PAF, 3.56%) and sinusitis (PAF, 2.76%), and was lowest for pneumonia and bronchitis (PAF, 0.41% for both). Conclusions: Our analysis found minimal evidence overall of diagnostic shifting after a stewardship intervention using audit and feedback in these pediatric clinics. Small changes in diagnostic coding may reflect more appropriate diagnosis and coding, a positive effect of audit and feedback, rather than intentional negative diagnostic shift.Funding: NoneDisclosures: None

scholarly journals 141. Implementation of Veterans Affairs Outpatient Antimicrobial Stewardship Interventions for Asymptomatic Bacteriuria and Acute Respiratory Infections, a Stepped Wedge Randomized Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S81-S82
Author(s):  
Grace Mortrude ◽  
Mary Rehs ◽  
Katherine Sherman ◽  
Nathan Gundacker ◽  
Claire Dysart
Keyword(s):  
Patient Satisfaction ◽  
Primary Outcome ◽  
Respiratory Infections ◽  
Asymptomatic Bacteriuria ◽  
Educational Interventions ◽  
Antibiotic Prescribing ◽  
Acute Respiratory Infections ◽  
Stepped Wedge ◽  
Post Intervention ◽  
The Impact

Abstract Background Outpatient antimicrobial prescribing is an important target for antimicrobial stewardship (AMS) interventions to decrease antimicrobial resistance in the United States. The objective of this study was to design, implement and evaluate the impact of AMS interventions focused on asymptomatic bacteriuria (ASB) and acute respiratory infections (ARIs) in the outpatient setting. Methods This randomized, stepped-wedge trial evaluated the impact of educational interventions to providers on adult patients presenting to primary care (PC) clinics for ARIs and ASB from 10/1/19 to 1/31/20. Data was collected by retrospective chart review. An antibiotic prescribing report card was provided to PC providers, then an educational session was delivered at each PC clinic. Patient education materials were distributed to PC clinics. Interventions were made in a step-wise (figure 1) fashion. The primary outcome was percentage of overall antibiotic prescriptions as a composite of prescriptions for ASB, acute bronchitis, upper-respiratory infection otherwise unspecified, uncomplicated sinusitis, and uncomplicated pharyngitis. Secondary outcomes included individual components of the primary outcome, a composite safety endpoint of related hospital, emergency department or primary care visit within 4 weeks, antibiotic appropriateness, and patient satisfaction surveys. Figure 1 Results There were 887 patients included for analysis (405 pre-intervention, 482 post-intervention). Baseline characteristics are summarized in table 1. After controlling for type 1 error using a Bonferroni correction the primary outcome was not significantly different between groups (56% vs 49%). There was a statistically significant decrease in prescriptions for bronchitis (20.99% vs 12.66%; p=0.0003). Appropriateness of prescriptions for sinusitis (OR 4.96; CI 1.79–13.75; p=0.0021) and pharyngitis (OR 5.36; CI 1.93 – 14.90; p=0.0013) was improved in the post-intervention group. The composite safety outcome and patient satisfaction survey ratings did not differ between groups. Table 1 Conclusion Multifaceted educational interventions targeting providers can improve antibiotic prescribing for indications rarely requiring antimicrobials without increasing re-visit or patient satisfaction surveys. Disclosures All Authors: No reported disclosures

scholarly journals 1959. Parent Satisfaction and Antibiotic Prescribing for Pediatric Respiratory Infections by Telemedicine

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S62-S62
Author(s):  
Charles B Foster ◽  
Martinez Kathryn ◽  
Camille Sabella ◽  
Gregory Weaver ◽  
Michael Rothberg
Keyword(s):  
Patient Satisfaction ◽  
Otitis Media ◽  
Respiratory Infections ◽  
Acute Otitis Media ◽  
Parent Satisfaction ◽  
Streptococcal Pharyngitis ◽  
Antibiotic Prescribing ◽  
Telemedicine Consultation ◽  
Visit Duration ◽  
Tract Infections

Abstract Background Respiratory tract infections (RTIs) are a common reason for direct-to-consumer (DTC) telemedicine consultation. Antibiotic prescribing during video-only DTC telemedicine consults was explored for pediatric RTIs, focusing on correlates with visit duration and patient satisfaction. Methods Data on pediatric (age less than 19 years) RTI consults were obtained from a large DTC nationwide telemedicine platform and included patient, physician, and encounter characteristics. Mixed-effects regression was used to assess variation in antibiotic receipt by patient and physician factors, as well as the association between antibiotic receipt and visit length or patient satisfaction. Results Of 12,842 RTI visits with 560 physicians, 55% of patients received an antibiotic prescription. Antibiotic prescribing rates among telemedicine providers were high: sinusitis (92.1%), otitis media (96.0%), pharyngitis (76.7%), and bronchitis/bronchiolitis (62.0%). A provider was more likely to receive a 5-star satisfaction rating from the parent when the child was provided a prescription for an antibiotic (OR 3.38; 95% CI 2.84–4.02), an antiviral (OR 2.56; 95% CI 1.81–3.64) or a nonantibiotic (OR 1.93; 95% CI 1.58–2.36). Visit length (mean 6.4 minute) was associated with higher satisfaction only when no antibiotic was prescribed (OR 1.03 per 6 seconds; 95% CI 1.01–1.06). Compared with nonpediatricians, pediatric providers were less likely to prescribe antibiotics (OR 0.44; 95% CI 0.29–0.68); however, patients of pediatricians were more likely to be highly satisfied (OR 1.50; 95% CI 1.11–2.03). Conclusion During DTC telemedicine video consultations for RTIs, pediatric patients were frequently prescribed antibiotics, which correlated with visit satisfaction. Although pediatricians prescribed antibiotics at a lower rate than other physicians, their satisfaction scores were higher. Especially problematic, adherence to guideline-concordant criteria for diagnosing acute otitis media and streptococcal pharyngitis, which, respectively, require otoscopy and throat culture, is not possible during a video-only telemedicine consult. High rates of antibiotic prescribing to children with RTIs suggest a need for antimicrobial stewardship efforts during video-only telemedicine consultation. Disclosures All Authors: No reported Disclosures.

scholarly journals 2568. Variability in Pediatric Antibiotic Prescribing for Upper Respiratory Illnesses by Provider Specialty

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S73-S74
Author(s):  
Holly M Frost ◽  
Huong McLean ◽  
Brian Chow
Keyword(s):  
Respiratory Infections ◽  
Group A Streptococcus ◽  
Acute Otitis Media ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Respiratory Illnesses ◽  
Upper Respiratory Infection ◽  
Medical Diagnoses ◽  
Group A ◽  
Upper Respiratory

Abstract Background Antibiotic prescribing varies among providers, contributing to antibiotic resistance and adverse drug reactions. Objective. To evaluate variation in antibiotic prescribing between pediatric and nonpediatric providers for common upper respiratory illnesses. Methods Patient encounters for children aged <18 years from a regional healthcare system were identified. Electronic medical records from 2011 to 2016 were extracted for diagnoses of upper respiratory infection (URI), pharyngitis, acute otitis media (AOM), and sinusitis. Encounters with competing medical diagnoses, recent hospitalization, and antibiotic prescriptions within 30 days were excluded. Adherence to antibiotic guidelines was assessed by provider training (pediatric, nonpediatric physicians, and advance practice providers [APP]). Additional factors assessed included clinic or urgent care setting, calendar year, and patient’s age, gender, insurance status, and number of sick visits in the prior year. Results Across 6 years, 141,361 visits were examined: 43,914 for URI, 43,701 for pharyngitis, 43,925 for AOM, and 9,821 for sinusitis. Pediatricians were more likely than APPs and nonpediatric providers to have guideline-concordant prescribing for pharyngitis (pediatricians 66.7 (54.5, 77.0)%, nonpediatricians 49.1 (36.3, 62.0)%, APPs 52.2(39.4, 64.7)%, P < 0.0001) and sinusitis (pediatricians 70.8(53.8, 83.4)%, nonpediatricians 63.3(46.8, 77.2)%, APPs 62.1(45.1, 76.5)%, P = 0.48) and to withhold antibiotics for URI than APPs and nonpediatric providers (pediatricians 86.6(81.2, 90.6)%, nonpediatricians 80.8(73.0, 86.8)%, APPs 76.8(68.4, 83.5)%, P < 0.0001). Pediatricians were less likely to prescribe antibiotics for pharyngitis without a positive Group A Streptococcus test than APPs and nonpediatric providers (pediatricians 15.1(10.4, 21.6)%, nonpediatricians 29.4(20.8, 39.6)%, APPs 27.2(19.3, 36.9)%, P < 0.0001). First-line antibiotic prescribing for pharyngitis and AOM did not differ between provider specialties. A trend toward more guideline-concordant prescribing was seen for pharyngitis and sinusitis over the study period. Conclusion Pediatricians were more likely to adhere to guidelines for pediatric acute respiratory infections. Pediatric antibiotic stewardship efforts should also target non-pediatricians. Disclosures All authors: No reported disclosures.

scholarly journals Update on Improving Outpatient Antibiotic Use Through Implementation and Evaluation of Core Elements of Outpatient Antibiotic

2020 ◽  
Vol 41 (S1) ◽  
pp. s422-s422
Author(s):  
Karl Madaras-Kelly ◽  
Christopher Hostler ◽  
Mary Townsend ◽  
Emily Potter ◽  
Emily Spivak ◽  
...  
Keyword(s):  
Respiratory Infections ◽  
Antibiotic Use ◽  
Infectious Complications ◽  
Audit And Feedback ◽  
Antibiotic Prescribing ◽  
The Core ◽  
Medication Effects ◽  
Core Elements ◽  
Appropriate Therapy ◽  
The Impact

Background: Acute respiratory infections (ARIs) are a key target to improve antibiotic use in the outpatient setting. The Core Elements of Outpatient Antibiotic Stewardship provide a framework for improving antibiotic use, but data on safety and effectiveness of interventions to improve antibiotic use are limited. We report the impact of Core Elements implementation within Veterans’ Healthcare Administration clinics on antibiotic prescribing and patient outcomes. Methods: The intervention targeting treatment of uncomplicated ARIs (sinusitis, pharyngitis, bronchitis, and viral upper respiratory infections [URIs]) in emergency department and primary care settings was initiated within 10 sites between September 2017 and January 2018. The intervention was developed using the Core Elements and included local site champions, audit-and-feedback with peer comparison, and academic detailing. We evaluated the following outcomes: per-visit antibiotic prescribing rates overall and by diagnosis; appropriateness of treatment; 30-day ARI revisits; 30-day infectious complications (eg,, pneumonia,); 30-day adverse medication effects; 90-day Clostridium difficile infection (CDI); and 30-day hospitalizations. Multilevel logistic regression was used to calculate rate ratios (RR) with 95% CI for each outcome in the postintervention period (12 months) compared to the preintervention period (39–42 months). Results: There were 14,020 uncomplicated ARI visits before the intervention and 4,866 uncomplicated ARI visits after the intervention. The proportions of uncomplicated ARI visits with antibiotics prescribed were 59.17% before the intervention versus 44.34% after the intervention. A trend in reduced antibiotic prescribing for ARIs throughout the entire (before and after) observation period was evident (0.92; 95% CI, 0.90–0.94); however, a significant reduction in antibiotic prescribing after the intervention was identified (0.74; 95% CI, 0.59–0.93). Per-visit antibiotic prescribing rates decreased significantly for bronchitis and URI (0.54; 95% CI, 0.44–0.65), pharyngitis (0.76; 95% CI, 0.67–0.86), and sinusitis (0.92; 95% CI, 0.85–1.0). Appropriate therapy for pharyngitis increased (1.43; 95% CI, 1.21–1.68), but appropriate therapy for sinusitis remained unchanged (0.92; 95% CI, 0.85–1.0) after the intervention. Complications associated with antibiotic undertreatment were not different after the intervention: ARI-related revisit rates (1.01; 95% CI, 0.98–1.05) and infectious complications (1.01; 95% CI, 0.79–1.28). A potential benefit of improved antibiotic use included a reduction in visits for adverse medication effects (0.82; 95% CI, 0.72–0.94). Furthermore, 90-day CDI events were too sparse to model: preintervention incidence was 0.08% and postintervention incidence was 0.06%. Additionally, 30-day hospitalizations were significantly lower in the postintervention period (0.79; 95% CI, 0.72–0.87). Conclusions: Implementation of the Core Elements was safe and effective and was associated with reduced antibiotic prescribing rates for uncomplicated ARIs, improvements in diagnosis-specific appropriate therapy, visits for adverse antibiotic effects, and 30-day hospitalization rates. No adverse events were noted in ARI-related revisit rates or infectious complications. CDI rates were low and unchanged.Funding: NoneDisclosures: None

scholarly journals Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e023989 ◽  
Author(s):  
Xiaohui Sun ◽  
Martin C Gulliford
Keyword(s):  
Broad Spectrum ◽  
Respiratory Infections ◽  
Relative Rate ◽  
Age Groups ◽  
Poisson Model ◽  
Population Based ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Antibiotic Prescribing ◽  
Diagnostic Coding

ObjectiveTo analyse individual-patient electronic health records to evaluate changes in antibiotic (AB) prescribing in England for different age groups, for male and female subjects, and by prescribing indications from 2014 to 2017.MethodsData were analysed for 102 general practices in England that contributed data to the UK Clinical Practice Research Datalink (CPRD) from 2014 to 2017. Prescriptions for all ABs and for broad-spectrum β-lactam ABs were evaluated. Relative rate reductions (RRR) were estimated from a random-effects Poisson model, adjusting for age, gender, and general practice.ResultsTotal AB prescribing declined from 608 prescriptions per 1000 person-years in 2014 to 489 per 1000 person-years in 2017; RRR 6.9% (95% CI 6.6% to 7.1%) per year. Broad-spectrum β-lactam AB prescribing decreased from 221 per 1000 person-years in 2014 to 163 per 1000 person-years in 2017; RRR 9.3% (9.0% to 9.6%) per year. Declines in AB prescribing were similar for men and women but the rate of decline was lower over the age of 55 years than for younger patients. All AB prescribing declined by 9.8% (9.6% to 10.1%) per year for respiratory infections, 5.7% (5.2% to 6.2%) for genitourinary infections, but by 3.8% (3.1% to 4.5%) for no recorded indication. Overall, 38.8% of AB prescriptions were associated with codes that did not suggest specific clinical conditions, and 15.3% of AB prescriptions had no medical codes recorded.ConclusionAntibiotic prescribing has reduced and become more selective but substantial unnecessary AB use may persist. Improving the quality of diagnostic coding for AB use will help to support antimicrobial stewardship efforts.

scholarly journals 969. Antibiotic Prescribing in a Large Retail Health Clinic Chain: Opportunities for Stewardship

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S32-S33
Author(s):  
Katherine E Fleming-Dutra ◽  
Laura M King ◽  
Safia Boghani ◽  
Lauri Hicks ◽  
John Hou ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Respiratory Infections ◽  
Acute Otitis Media ◽  
Adult Patients ◽  
Urgent Care ◽  
Health Clinic ◽  
Antibiotic Prescribing ◽  
First Line

Abstract Background Retail health is a growing outpatient setting. Research using claims data found that antibiotics were linked with 46% of urgent care, 17% of medical office, and 14% of retail health visits for acute respiratory infections (ARIs) for which antibiotics are not needed. We aimed to quantify antibiotic prescribing rates to adult patients in a large retail health clinic chain using electronic health records and to identify future stewardship targets. Methods We included visits by adults ≥18 years to network retail health clinics from 2012 to 2016. We classified diagnoses by ICD codes. We calculated the percent of visits with systemic antibiotics prescribed among all visits, by individual diagnosis, and for ARIs as a group (e.g., pneumonia, sinusitis, pharyngitis, acute otitis media [AOM], bronchitis, and viral upper respiratory infections [URI]). We also assessed the percent of visits for sinusitis and pharyngitis with first-line antibiotics prescribed. Results Of 2,893,413 visits by adults during 2012–2016, 1,866,145 (66%) resulted in antibiotic prescriptions. ARIs accounted for 2,039,423 (72%) of visits and 1,475,069 (79%) of antibiotic prescriptions. The most common diagnoses regardless of antibiotic prescription were sinusitis (31% of visits), pharyngitis (15%, of which 81% were coded as streptococcal pharyngitis), urinary tract infection (9%), viral URI (8%), AOM (7%), and bronchitis (5%). Antibiotics were frequently prescribed for sinusitis, urinary tract infection, pharyngitis, and AOM but not for viral URI and bronchitis (Figure 1). First-line antibiotics were prescribed in the majority of sinusitis and pharyngitis visits (Figure 2). Conclusion ARIs are major drivers of visits by adult patients and of antibiotic prescribing to adults in this retail clinic network. Inappropriate antibiotic use was low in this setting for viral URI and bronchitis and first-line antibiotic selection was high for sinusitis and pharyngitis, although additional opportunities for improvement exist. Future antibiotic stewardship efforts may target examining adherence to guideline-recommended diagnostic criteria for sinusitis, AOM, and pharyngitis and increasing use of watchful waiting for sinusitis and AOM. Disclosures All Authors: No reported Disclosures.

scholarly journals The impact of COVID-19 on outpatient antibiotic prescriptions in Ontario, Canada; An interrupted time series analysis

2021 ◽  
Author(s):  
Taito Kitano ◽  
Kevin A Brown ◽  
Nick Daneman ◽  
Derek R MacFadden ◽  
Bradley J Langford ◽  
...  
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Respiratory Infections ◽  
Population Level ◽  
Interrupted Time Series ◽  
Relative Reduction ◽  
Antibiotic Prescribing ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
The Impact

Abstract Background The COVID-19 pandemic has potentially impacted outpatient antibiotic prescribing. Investigating this impact may identify stewardship opportunities in the ongoing COVID-19 period and beyond. Methods We conducted an interrupted time series analysis on outpatient antibiotic prescriptions and antibiotic prescriptions/patient visits in Ontario, Canada between January 2017 and December 2020 to evaluate the impact of the COVID-19 pandemic on population-level antibiotic prescribing by prescriber’s specialty, patient demographics and conditions. Results In the evaluated COVID-19 period (March-December 2020), there was a 31.2% [95% CI: 27.0%–35.1%] relative reduction in total antibiotic prescriptions. Total outpatient antibiotic prescriptions decreased during the COVID-19 period by 37.1% [32.5%–41.3%] among family physicians, 30.7% [25.8%–35.2%] among sub-specialist physicians, 12.1% [4.4%–19.2%] among dentists and 25.7% [21.4%–29.8%] among other prescribers. Antibiotics indicated for respiratory infections decreased by 43.7% [38.4–48.6%]. Total patient visits and visits for respiratory infections decreased by 10.7% [5.4%–15.6%] and 49.9% [43.1%%–55.9%]). Total antibiotic prescriptions/1,000 visits decreased by 27.5% [21.5%–33.0%], while antibiotics indicated for respiratory infections/1,000 visits with respiratory infections only decreased by 6.8% [2.7%–10.8%]. Conclusion The reduction in outpatient antibiotic prescribing during the COVID-19 pandemic was driven by less antibiotic prescribing for respiratory indications and largely explained by decreased visits for respiratory infections.

scholarly journals 1347. Improved Antibiotic Prescribing Practices for Respiratory Infections Through Use of Computerized Order Sets and Educational Sessions in Pediatric Clinics

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S684-S685
Author(s):  
Yorgo Zahlanie ◽  
Norman Mang ◽  
Kevin Lin ◽  
Linda S Hynan ◽  
Bonnie C Prokesch
Keyword(s):  
Antimicrobial Stewardship ◽  
Outpatient Treatment ◽  
Respiratory Infections ◽  
Antibiotic Prescribing ◽  
Acute Respiratory Infections ◽  
First Line ◽  
Post Intervention ◽  
Treatment Pathways ◽  
Order Sets ◽  
Antibiotic Duration

Abstract Background The literature about comprehensive outpatient antimicrobial stewardship programs remains sparse. However, computerized clinical decision support systems (CDSSs) have shown promising effectiveness in improving outpatient antibiotic prescribing. Methods We developed an intervention in the form of EPIC order sets comprised of outpatient treatment pathways for 3 pediatric bacterial acute respiratory infections or ARIs (otitis media, community-acquired pneumonia, and streptococcal pharyngitis) coupled with educational sessions. Two study periods were included, and 4 pediatric clinics were randomized into intervention and control arms. Education was provided to the 2 intervention clinics between the study periods, and EPIC order sets became available to these 2 clinics at the beginning of the post-intervention period. The primary endpoint was the rate of first-line antibiotic prescribing, and the secondary endpoints included antibiotic duration and antibiotic prescription modification within 14 days. Results A total of 2690 antibiotic prescriptions were written for bacterial ARIs. At pre-intervention, there was no difference between the study arms in terms of first-line antibiotic prescribing (74.9% vs. 77.7%, P=0.211) and antibiotic duration (9.69 ±0.96 days vs. 9.63 ±1.07 days, P>0.999). Following the intervention, the intervention clinics had higher rate of first-line antibiotic prescribing (83.1% vs. 77.7%, P=0.024) and shorter antibiotic duration (9.28 ±1.56 days vs. 9.79 ±0.75 days, P< 0.001) compared to the control clinics. The rate of modified antibiotics was small in all clinics (1.1-1.6%) and not different at pre-intervention (P=0.852) and post-intervention (P=0.552). Analysis of categorical variables Analysis of continuous variables Distribution of the antibiotic prescriptions among the 3 bacterial acute respiratory infections Conclusion A computerized CDSS involving treatment pathways in the form of order sets coupled with educational sessions was associated with a higher rate of first-line antibiotic prescribing and shorter antibiotic duration for the outpatient treatment of bacterial ARIs. More studies are needed in order to assess the utility of multimodal approaches in pediatric outpatient antimicrobial stewardship. Disclosures All Authors: No reported disclosures

scholarly journals Strategies Used for Implementing and Promoting Adherence to Antibiotic Guidelines in Low- and Lower-Middle-Income Countries: A Systematic Review

2021 ◽  
Vol 6 (3) ◽  
pp. 166
Author(s):  
Nicola D. Foxlee ◽  
Nicola Townell ◽  
Claire Heney ◽  
Lachlan McIver ◽  
Colleen L. Lau
Keyword(s):  
Clinical Guidelines ◽  
Antibiotic Consumption ◽  
Audit And Feedback ◽  
World Health ◽  
Cochrane Library ◽  
Antibiotic Prescribing ◽  
Post Intervention ◽  
Middle Income ◽  
Positive Direction ◽  
Middle Income Countries

Containing antimicrobial resistance and reducing high levels of antibiotic consumption in low- and lower middle-income countries are a major challenge. Clinical guidelines targeting antibiotic prescribing can reduce consumption, however, the degrees to which clinical guidelines are adopted and adhered to are challenging for developers, policy makers and users. The aim of this study was to review the strategies used for implementing and promoting antibiotic guideline adherence in low- and lower middle-income countries. A review of published literature was conducted using PubMed, Cochrane Library, SCOPUS and the information systems of the World Health Organization and the Australian National University according to PRISMA guidelines and our PROSPERO protocol. The strategies were grouped into five broad categories based on the Cochrane Effective Practice and Organization of Care taxonomy. The 33 selected studies, representing 16 countries varied widely in design, setting, disease focus, methods, intervention components, outcomes and effects. The majority of interventions were multifaceted and resulted in a positive direction of effect. The nature of the interventions and study variability made it impossible to tease out which strategies had the greatest impact on improving CG compliance. Audit and feedback coupled with either workshops and/or focus group discussions were the most frequently used intervention components. All the reported strategies are established practices used in antimicrobial stewardship programs in high-income countries. We recommend interrupted time series studies be used as an alternative design to pre- and post-intervention studies, information about the clinical guidelines be made more transparent, and prescriber confidence be investigated.

scholarly journals Prescrição Antibiótica no Ambulatório em Doentes Pediátricos com Patologia Respiratória

2019 ◽  
Vol 32 (2) ◽  
pp. 101 ◽  
Author(s):  
Joana Verdelho Andrade ◽  
Pedro Vasconcelos ◽  
Joana Campos ◽  
Teresa Camurça
Keyword(s):  
Otitis Media ◽  
Family Physician ◽  
Clinical Guideline ◽  
Respiratory Infections ◽  
Acute Otitis Media ◽  
Antibiotic Prescribing ◽  
Acute Tonsillitis ◽  
The Family ◽  
Tract Infections ◽  
Clinical Records

Introduction: Respiratory tract infections represent the most frequent conditions in pediatric clinical practice that motivate antibiotic prescribing. The objective was to identify the frequency and pattern of antibacterial prescribing in respiratory diseases.Material and Methods: Over a period of two years (divided by the presentation of the clinical guideline standards) data was collected from clinical records of children with respiratory disease. Chi-square tests or Fisher’s exact test were used to test associations between variables, statistical significance p < 0.05.Results: There were 547 visits (mean age 6 years ± 5.3, 55% male gender). Analysis for Group A Streptococcus of the oropharynx was most frequently requested by pediatric residents (p = 0.005). Chest x-rays were more frequently requested by the Family Physician (p = 0.033). An antibiotic was prescribed in 87% of pneumonias, 84% acute otitis media, 68% acute tonsillitis, 25% laryngitis, 17% upper respiratory infections, 16% acute bronchiolitis. The Family Physician prescribed antibiotics more often than the Pediatrics resident in acute tonsillitis (p = 0.003) and in acute otitis media (p = 0.013). The most frequently prescribed antibiotic was amoxicillin (61%). There were no significant differences between the two periods studied regarding the number of prescriptions and antibiotic choice of the conditions studied.Discussion: Antibiotic prescribing in pediatric acute respiratory infections was high and the choice of antibiotic therapy could be adjusted. We found no difference in antibiotic prescribing after the presentation of the clinical guideline standards.Conclusion: An improvement in the antibiotic prescription in children and adolescents in the outpatient clinic is considered necessary.

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