22. Patient Satisfaction Remains Unchanged Following Implementation of an Antibiotic Stewardship Intervention in Primary Care

Abstract Background Inappropriate prescription of antibiotics for respiratory tract infections (RTIs) in ambulatory care settings is common, increasing the risk of adverse health outcomes. Behavioral and educational interventions targeting primary care providers (PCPs) have shown promise in reducing inappropriate antibiotic prescribing for RTIs. While one perceived barrier to such interventions is the concern that these adversely impact patient satisfaction, few data exist in this area. Here, we examine whether a recent PCP-targeted intervention that significantly reduced antibiotic prescribing for RTIs was associated with a change in patient satisfaction. Methods The PCP-targeted intervention involved monthly education sessions and peer benchmarking reports delivered to 31 clinics within an academic health system, and was previously shown to reduce antibiotic prescribing. Here, we performed a retrospective, secondary analysis of Press Ganey (PG) surveys associated with the outpatient encounters in the pre- and post-intervention periods. We evaluated the impact on patient perceptions of PCPs based on provider exposure to the intervention using a mixed effects logistic regression model. Results There were 17,416 out of 197,744 encounters (8.8%) with associated PG surveys for the study time period (July 2016 to September 2018). In the multivariate model, patient satisfaction with PCPs was most strongly associated with patient-level characteristics (age, race, health status, education status) and survey-level characteristics (survey response time, patient’s usual provider) (Figure 1). Satisfaction with PCPs did not change following delivery of the provider-based intervention even after adjusting for patient- and survey-level characteristics [adjusted odds ratio (95% CI): 1.005 (0.928, 1.087)]. However, a small increase in satisfaction associated with receiving antibiotics during the entire study period was seen [adjusted odds ratio (95% CI): 1.146 (1.06, 1.244)]. Figure 1: Association of a provider-targeted intervention as well as patient, provider, and practice characteristics with patient satisfaction in a multivariable mixed effects logistic regression model Conclusion Patient perceptions of PCPs remain unchanged following the delivery of a behavioral and educational intervention to primary care providers that resulted in observable decreases in antibiotic prescribing practices for RTIs. Disclosures All Authors: No reported disclosures

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145. Monthly Antibiotic Prescribing Peer Comparison Combined with In-person Education Decreases Antibiotic Prescribing for Acute Respiratory Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.190 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S83-S83

Author(s):

Shelby J Kolo ◽

David J Taber ◽

Ronald G Washburn ◽

Katherine A Pleasants

Keyword(s):

Primary Care ◽

Respiratory Infections ◽

Primary Care Providers ◽

The United States ◽

Delivery Mode ◽

Antibiotic Prescribing ◽

Acute Respiratory Infections ◽

Care Providers ◽

Intervention Period ◽

Provider Education

Abstract Background Inappropriate antibiotic prescribing is an important modifiable risk factor for antibiotic resistance. Approximately half of all antibiotics prescribed for acute respiratory infections (ARIs) in the United States may be inappropriate or unnecessary. The purpose of this quality improvement (QI) project was to evaluate the effect of three consecutive interventions on improving antibiotic prescribing for ARIs (i.e., pharyngitis, rhinosinusitis, bronchitis, common cold). Methods This was a pre-post analysis of an antimicrobial stewardship QI initiative to improve antibiotic prescribing for ARIs in six Veterans Affairs (VA) primary care clinics. Three distinct intervention phases occurred. Educational interventions included training on appropriate antibiotic prescribing for ARIs. During the first intervention period (8/2017-1/2019), education was presented virtually to primary care providers on a single occasion. In the second intervention period (2/2019-10/2019), in-person education with peer comparison was presented on a single occasion. In the third intervention period (11/2019-4/2020), education and prescribing feedback with peer comparison was presented once in-person followed by monthly emails of prescribing feedback with peer comparison. January 2016-July 2017 was used as a pre-intervention baseline period. The primary outcome was the antibiotic prescribing rate for all classifications of ARIs. Secondary outcomes included adherence to antibiotic prescribing guidance for pharyngitis and rhinosinusitis. Descriptive statistics and interrupted time series segmented regression were used to analyze the outcomes. Results Monthly antibiotic prescribing peer comparison emails in combination with in-person education was associated with a statistically significant 12.5% reduction in the rate of antibiotic prescribing for ARIs (p=0.0019). When provider education alone was used, the reduction in antibiotic prescribing was nonsignificant. Conclusion Education alone does not significantly reduce antibiotic prescribing for ARIs, regardless of the delivery mode. In contrast, education followed by monthly prescribing feedback with peer comparison was associated with a statistically significant reduction in ARI antibiotic prescribing rates. Disclosures All Authors: No reported disclosures

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A Scoping Review of Trauma-Informed Curricula for Primary Care Providers

Family Medicine ◽

10.22454/fammed.2021.500263 ◽

2021 ◽

Vol 53 (10) ◽

pp. 843-856

Author(s):

Constance Gundacker ◽

Tyler W. Barreto ◽

Julie P. Phillips

Keyword(s):

Primary Care ◽

Patient Satisfaction ◽

Health Outcomes ◽

Primary Care Providers ◽

The United States ◽

Traumatic Experiences ◽

Search Term ◽

Care Providers ◽

Trauma Informed ◽

The Impact

Background and Objectives: Traumatic experiences such as abuse, neglect, and household dysfunction have a lifetime prevalence of 62%-75% and can negatively impact health outcomes. However, many primary care providers (PCPs) are inadequately prepared to treat patients with trauma due to a lack of training. Our objective was to identify trauma-informed approach curricula for PCPs, review their effectiveness, and identify gaps. Methods: We systematically identified articles from Medline, Scopus, Web of Science, Academic Search Premier, Cochrane, PsycINFO, MedEd Portal, and the STFM Resource Library. Search term headings “trauma-informed care (TIC),” “resilience,” “patient-centered care,” “primary care,” and “education.” Inclusion criteria were PCP, pediatric and adult patients, and training evaluation. Exclusion criteria were outside the United States, non-English articles, non-PCPs, and inpatient settings. We used the TIC pyramid to extract topics. We analyzed evaluation methods using the Kirkpatrick Model. Results: Researchers reviewed 6,825 articles and identified 17 different curricula. Understanding health effects of trauma was the most common topic (94%). Evaluation data revealed overall positive reactions and improved knowledge, attitudes, and confidence. Half (53%) reported Kirkpatrick level 3 behavior change evaluation outcomes with increased trauma screening and communication, but no change in referrals. Only 12% (2/17) evaluated Kirkpatrick level 4 patient satisfaction (significant results) and health outcomes (not significant). Conclusions: Pilot findings from studies in our review show trauma-informed curricula for PCPs reveal positive reactions, an increase in knowledge, screening, communication, and patient satisfaction, but no change in referrals or health outcomes. Further research is needed to examine the impact of trainings on quality of care and health outcomes.

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Is patient satisfaction in primary care dependent on structural and organizational characteristics among providers? Findings based on data from the national patient survey in Sweden

Health Economics Policy and Law ◽

10.1017/s1744133112000333 ◽

2012 ◽

Vol 8 (3) ◽

pp. 317-333 ◽

Cited By ~ 12

Author(s):

Anna H. Glenngård

Keyword(s):

Primary Care ◽

Patient Satisfaction ◽

Social Deprivation ◽

Primary Care Providers ◽

Patient Survey ◽

Structural Factors ◽

Care Providers ◽

Factors Affecting ◽

Provider Performance ◽

National Patient

AbstractIn parallel to market-like reforms in Swedish primary care, the gathering and compilation of comparative information about providers, for example through survey tools, has been improved. Such information is increasingly being used to guide individuals’ choice of provider and payers’ assessments of provider performance, often without critically reflecting about underlying factors affecting the results. The purpose of this study was to analyze variation in patient satisfaction, with respect to organizational and structural factors, including the mix of registered individuals, among primary care providers, based on information from a national patient survey in primary care and register data in three Swedish county councils. Systematic variation in patient satisfaction was found with respect to both organizational and structural factors, including characteristics of registered individuals. Smaller practices and practices where a high proportion of all visits were with a doctor were associated with higher patient satisfaction. Also practices where registered individuals had a low level of social deprivation and a high overall illness on average were associated with higher patient satisfaction. Factors that are of relevance for how well providers perform according to patient surveys are more or less possible to control for providers. This adds to the complexity for the use of such information by individuals and payers to assess provider performance.

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Measuring Patient Satisfaction Outcomes Across Provider Disciplines

Journal of Nursing Measurement ◽

10.1891/1061-3749.7.1.47 ◽

1999 ◽

Vol 7 (1) ◽

pp. 47-62 ◽

Cited By ~ 6

Author(s):

Gene W. Marsh

Keyword(s):

Primary Care ◽

Health Care ◽

Patient Satisfaction ◽

Care Setting ◽

Primary Care Providers ◽

Care Providers ◽

Methodological Research ◽

Instrument Measuring ◽

Explained Variance ◽

Unidimensional Scale

The purpose of this methodological research was to modify and test an instrument measuring patient satisfaction outcomes with primary care providers who represent different disciplines. The Patient Satisfaction with Health Care Provider Scale (PSHCPS) was adapted from a questionnaire indexing four satisfaction dimensions: Access, Humaneness, Quality, and General Satisfaction (Gherkin, Hart, & Rosenblatt, 1988). Following modification, the PSHCPS was administered to 167 adults with NP or MD providers at a university-based, managed-care setting for the medically indigent. The total scale Cronbach’ s alpha was .93. Factor analysis supported an unidimensional scale with 18 items loading above .40 and 43% explained variance.

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Prevalence of Inappropriate Antibiotic Prescribing in Primary Care Clinics within a Veterans Affairs Health Care System

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00337-18 ◽

2018 ◽

Vol 62 (8) ◽

Cited By ~ 25

Author(s):

Nathan R. Shively ◽

Deanna J. Buehrle ◽

Cornelius J. Clancy ◽

Brooke K. Decker

Keyword(s):

Primary Care ◽

Health Care ◽

Tract Infection ◽

Health Care System ◽

Primary Care Providers ◽

Acute Respiratory Tract Infection ◽

Chronic Obstructive ◽

Antibiotic Prescribing ◽

Care Providers ◽

Care System

ABSTRACT Data are needed from outpatient settings to better inform antimicrobial stewardship. In this study, a random sample of outpatient antibiotic prescriptions by primary care providers (PCPs) at our health care system was reviewed and compared to consensus guidelines. Over 12 months, 3,880 acute antibiotic prescriptions were written by 76 PCPs caring for 40,734 patients (median panel, 600 patients; range, 33 to 1,547). PCPs ordered a median of 84 antibiotic prescriptions per 1,000 patients per year. Azithromycin (25.8%), amoxicillin-clavulanate (13.3%), doxycycline (12.4%), amoxicillin (11%), fluoroquinolones (11%), and trimethoprim-sulfamethoxazole (10.6%) were prescribed most commonly. Medical records corresponding to 300 prescriptions from 59 PCPs were analyzed in depth. The most common indications for these prescriptions were acute respiratory tract infection (28.3%), urinary tract infection (23%), skin and soft tissue infection (15.7%), and chronic obstructive pulmonary disease (COPD) exacerbation (6.3%). In 5.7% of cases, no reason for the prescription was listed. No antibiotic was indicated in 49.7% of cases. In 12.3% of cases, an antibiotic was indicated, but the prescribed agent was guideline discordant. In another 14% of cases, a guideline-concordant antibiotic was given for a guideline-discordant duration. Therefore, 76% of reviewed prescriptions were inappropriate. Ciprofloxacin and azithromycin were most likely to be prescribed inappropriately. A non-face-to-face encounter prompted 34% of prescriptions. The condition for which an antibiotic was prescribed was not listed in primary or secondary diagnosis codes in 54.5% of clinic visits. In conclusion, there is an enormous opportunity to reduce inappropriate outpatient antibiotic prescriptions.

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Patient satisfaction and provider use of electronic communication: A cross-sectional analysis

European Journal for Person Centered Healthcare ◽

10.5750/ejpch.v5i4.1352 ◽

2017 ◽

Vol 5 (4) ◽

pp. 441 ◽

Cited By ~ 2

Author(s):

Joy L Lee ◽

Sydney M. Dy ◽

Steven J. Kravet ◽

Bimal H. Ashar ◽

Todd Nesson ◽

...

Keyword(s):

Primary Care ◽

Patient Satisfaction ◽

Text Messaging ◽

Primary Care Providers ◽

Care Providers ◽

Cross Sectional ◽

Communication Behaviors ◽

Cross Sectional Analysis ◽

Sectional Analysis ◽

The Relationship

Background: The way patients and providers communicate with one another outside of the clinic is changing. However, little is known about primary care provider perspectives and experiences of these changes and whether these provider behaviors correlate with patient satisfaction. This study examines provider patterns of communication with patients outside of the clinic setting via cellphone, email and text messaging and the relationship between communication behaviors and patient satisfaction. Method: Cross-sectional analysis of the association between patient satisfaction scores and a 16-question community survey of 149 Mid-Atlantic primary care providers in community practice was conducted in the year prior to clinic implementation of a new electronic health record system with secure patient-messaging capabilities.Results: Providers who gave patients their email addresses were more likely to communicate with their patients electronically than those who did not. Providers who made their email addresses available to patients also had significantly higher overall satisfaction scores than those who did not, although there were no statistically significant differences in individual satisfaction domains. The use of these cellphone, email and text-messaging were also not found to be associated with patient satisfaction domains. Conclusions: Provider provision of their email addresses may be an indicator of a stronger relationship with certain patients. This study elucidates the relationship between provider communication behaviors and patient satisfaction. A better understanding of the role of the patient-provider relationship and its role in patient satisfaction may help practices and providers improve their patients’ experience of primary care.

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Patient satisfaction between primary care providers and hospitals: a cross-sectional survey in Jilin province, China

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzw038 ◽

2016 ◽

Vol 28 (3) ◽

pp. 346-354 ◽

Cited By ~ 16

Author(s):

Jinghua Li ◽

Pingping Wang ◽

Xuan Kong ◽

Hailun Liang ◽

Xiumin Zhang ◽

...

Keyword(s):

Primary Care ◽

Patient Satisfaction ◽

Primary Care Providers ◽

Jilin Province ◽

Care Providers ◽

Cross Sectional Survey ◽

Cross Sectional

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A pragmatic randomized trial of a primary care antimicrobial stewardship intervention in Ontario, Canada

BMC Family Practice ◽

10.1186/s12875-021-01536-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Warren McIsaac ◽

Sahana Kukan ◽

Ella Huszti ◽

Leah Szadkowski ◽

Braden O’Neill ◽

...

Keyword(s):

Primary Care ◽

Antimicrobial Stewardship ◽

Care Provider ◽

Primary Care Provider ◽

Antibiotic Use ◽

Primary Care Providers ◽

Audit And Feedback ◽

Antibiotic Prescribing ◽

Care Providers ◽

Tract Infections

Abstract Background More than 90% of antibiotics are prescribed in primary care, but 50% may be unnecessary. Reducing unnecessary antibiotic overuse is needed to limit antimicrobial resistance. We conducted a pragmatic trial of a primary care provider-focused antimicrobial stewardship intervention to reduce antibiotic prescriptions in primary care. Methods Primary care practitioners from six primary care clinics in Toronto, Ontario were assigned to intervention or control groups to evaluate the effectiveness of a multi-faceted intervention for reducing antibiotic prescriptions to adults with respiratory and urinary tract infections. The intervention included provider education, clinical decision aids, and audit and feedback of antibiotic prescribing. The primary outcome was total antibiotic prescriptions for these infections. Secondary outcomes were delayed prescriptions, prescriptions longer than 7 days, recommended antibiotic use, and outcomes for individual infections. Generalized estimating equations were used to estimate treatment effects, adjusting for clustering by clinic and baseline differences. Results There were 1682 encounters involving 54 primary care providers from January until May 31, 2019. In intervention clinics, the odds of any antibiotic prescription was reduced 22% (adjusted Odds Ratio (OR) = 0.78; 95% Confidence Interval (CI) = 0.64.0.96). The odds that a delay in filling a prescription was recommended was increased (adjusted OR=2.29; 95% CI=1.37, 3.83), while prescription durations greater than 7 days were reduced (adjusted OR=0.24; 95% CI=0.13, 0.43). Recommended antibiotic use was similar in control (85.4%) and intervention clinics (91.8%, p=0.37). Conclusions A community-based, primary care provider-focused antimicrobial stewardship intervention was associated with a reduced likelihood of antibiotic prescriptions for respiratory and urinary infections, an increase in delayed prescriptions, and reduced prescription durations. Trial registration clinicaltrials.gov (NCT03517215).

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Abstract WP394: Needs of Stroke Survivors Post Hospital Discharge Stroke Follow-up Call

Stroke ◽

10.1161/str.48.suppl_1.wp394 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Joseph Mojares ◽

Sherydahn Aldrich ◽

Maria Novales-Fiel

Keyword(s):

Primary Care ◽

Patient Satisfaction ◽

Hospital Readmissions ◽

Primary Care Providers ◽

Phone Call ◽

Care Providers ◽

Stroke Patients ◽

Post Discharge ◽

Stroke Education

Background: This project attempts to discover the subjective response needs of 30-day post-acute stroke patients and their family members that were treated in two Northern California hospitals. The goal is to determine the functional level of the Stroke Survivor (SS) as measured by the Modified Rankin Scale (mRS) and to identify post-discharge needs. Purpose: The objective of this project is to identify the patient’s mRS score and post-discharge needs. The study includes stroke education reinforcement, primary care physician follow-up, ancillary services follow-up, discern hospital readmissions rates, and increase patient satisfaction. Methods: A list of discharged acute ischemic stroke patients over a three month period was provided to the Stroke Nurse Champion (SNC). A stroke phone call template was created to elicit the patient’s history, diagnosis, and mRS score. Patients with intracranial hemorrhage diagnosis, patients discharged to Skilled Nursing Facilities, and deceased patients were excluded from the study. The SNC performed chart review to determine patient course of hospitalization and stroke care management; places follow-up phone call to patient or family member; and identify the SS needs. When needs were discovered, they were addressed using electronic in-house messaging to patient’s primary care providers and ancillary staff. Results: Of the 63 participants, nine required stroke resource follow-up. The average mRS score of 1.84 revealed the patient’s knowledge of self-management to be 100%. There were 13 cases that needed outpatient therapy and Home Health therapy with mRS >2. The study outcome includes readmission rate of 0.03% (n=2) and stroke patient satisfaction >12.5%. Conclusions: Based on the mRS score, the SS appropriately met the level of care including rehabilitation needs at home. Post discharge needs of SS included psychosocial support, medication modification and appropriate durable medical equipment. Overall, the SS were satisfied with their care with low incidence of hospital readmission due to their stroke education provided during their hospitalization. Further plans for each hospital facility to consider continuing this project or to change the focus to outpatient support services as well.

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