scholarly journals 220. Comparing Antibiotic Prescription Practices, and Provider’s Perceptions of Such Rates, Among Urgent Care and Non-Urgent Care Clinicians at One of the Nation’s Largest Federally Qualified Health Centers

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S111-S112
Author(s):  
Ramzi W Ben-Yelles ◽  
Brittany Hopkins ◽  
Sherrill Brown ◽  
Sonali Saluja
Keyword(s):  
Antibiotic Prescription ◽  
Inappropriate Prescribing ◽  
The United States ◽  
Health Centers ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Care Providers ◽  
Prescribing Practices ◽  
Federally Qualified Health Centers ◽  
Prescription Practices

Abstract Background Inappropriate antibiotic prescribing practices, and the resulting development of antibiotic resistance, contribute to a growing health emergency worldwide. In reviewing data from 2010–2011, it was estimated that over 30% of ambulatory antibiotic prescriptions in the United States are non-essential.1 Altamed, one of the nation’s largest federally qualified health centers, operates 21 clinics across Southern California and serves the primary care needs of a high-volume, socioeconomically disadvantaged, predominantly Hispanic population. Citation 1 Methods We conducted an evaluation on the inappropriate antibiotic prescribing rate for Upper Respiratory Infections (URI) among all providers at Altamed (n=400). We limited our scope of encounters to cases of uncomplicated, acute bronchitis (URI) that occurred between January and December 2018. ICD 10 codes identified URIs, with exclusion criteria limiting confounding variables, charting errors, and dual diagnoses. Additionally, provider perceptions and mechanism for their antibiotic prescription practices were assessed with a de-identified 17 question, Likert-scale assessment (n=90). Results Of the encounters for URI seen by urgent care providers, 11.09% had inappropriate antibiotic prescriptions written. This is significantly different from encounters by non-urgent care providers, where 9.13% were deemed inappropriate (p=0.016). Despite this, providers were not uniform in believing their own antibiotic prescription rates to be as successful, with many estimating that their rate of CDC guideline concordance to fall below 90%. However, in their survey responses, providers as a whole report following healthy prescribing practices, identifying needs in their communities to recognize when it was inappropriate to prescribe an antibiotic, though they requested increased access to and education on antibiograms. Graph 1 Table 1 Graph 2 Conclusion Our study limitations included uneven or incomplete charting, the narrow time frame of the study, and the limited survey response rate of Altamed providers. Nevertheless, we are able to ascertain that inappropriate prescribing practices continue to be a challenge in the outpatient setting and are of greater concern among urgent care providers. Disclosures All Authors: No reported disclosures

Reducing Outpatient Antibiotic Prescribing for Acute Respiratory Infections: A Quasi-Experimental Study

2018 ◽  
Vol 11 (1) ◽  
pp. 3-15
Author(s):  
Cynthia Alicia Brown
Keyword(s):  
Experimental Study ◽  
Antibiotic Resistance ◽  
The United States ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Care Providers ◽  
Prescribing Practices ◽  
Post Intervention ◽  
Antibiotic Overuse ◽  
Quasi Experimental

Problem:Approximately 50% of antibiotics prescribed are not necessary; nevertheless, in the United States among the many outpatient prescriptions, there are few more widely prescribed than antibiotics. The overuse of antibiotics to treat viral infections has been largely responsible for the emergence of antibiotic resistance.Methods:A quasi-experimental study was conducted among a sample of eight urgent care providers who received the 1-hour Reducing Outpatient Antibiotic Resistance (ROAR) educational intervention on antibiotic overuse and appropriate prescribing. Outcomes measured included provider antibiotic prescribing rates for viral illnesses before and after intervention, prescribing practices among the providers, and provider awareness and beliefs regarding antibiotic prescribing and resistance.Results:The antibiotic prescribing rate decreased from 30% to 20% after intervention, p = .078. Pre-intervention patients had a 3.3 times (p = .001) and post-intervention patients had a 4.2 times (p ≤ .0005) greater likelihood of being prescribed an antibiotic if they were seen by a physician than if they were seen by a nurse practitioner. Within their setting, 87% believed antibiotics are overused, and 99% believed antibiotic resistance is a problem.Discussion:Additional research utilizing the ROAR intervention is necessary to evaluate its effect on antibiotic prescribing in the urgent care setting.

scholarly journals 142. Implementing an Antimicrobial Stewardship Program in the Outpatient Setting

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S82-S82
Author(s):  
Travis B Nielsen ◽  
Maressa Santarossa ◽  
Beatrice D Probst ◽  
Laurie Labuszewski ◽  
Jenna Lopez ◽  
...  
Keyword(s):  
Primary Care ◽  
Antimicrobial Stewardship ◽  
Inappropriate Prescribing ◽  
The United States ◽  
Outpatient Setting ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Antimicrobial Stewardship Program ◽  
Post Intervention ◽  
Stewardship Program

Abstract Background Antimicrobial-resistant infections lead to increased morbidity, mortality, and healthcare costs. Among the most facile modifiable risk factors for developing resistance is inappropriate prescribing. The CDC estimates that 47 million (or ≥30% of) outpatient antibiotic prescriptions in the United States are unnecessary. This has provided impetus for expanding our antimicrobial stewardship program (ASP) into the outpatient setting. Initial goals included the following: continuous evaluation and reporting of antibiotic prescribing compliance; minimize underuse of antibiotics from delayed diagnoses and misdiagnoses; ensure proper drug, dose, and duration; improve the percentage of appropriate prescriptions. Methods To achieve these goals, we first sent a baseline survey to outpatient prescribers, assessing their understanding of stewardship and antimicrobial resistance. Questions were modeled from the Illinois Department of Public Health (IDPH) Precious Drugs & Scary Bugs Campaign. The survey was sent to prescribers at 19 primary care and three immediate/urgent care clinics. Compliance rates for prescribing habits were subsequently tracked via electronic health records and reported to prescribers in accordance with IRB approval. Results Prescribers were highly knowledgeable about what constitutes appropriate prescribing, with verified compliance rates highly concordant with self-reported rates. However, 74% of respondents reported intense pressure from patients to inappropriately prescribe antimicrobials. Compliance rates have been tracked since December 2018 and comparing pre- with post-intervention rates shows improvement in primary care since reporting rates to prescribers in August 2019. Conclusion Reporting compliance rates has been helpful in avoiding inappropriate antimicrobial therapy. However, the survey data reinforce the importance of behavioral interventions to bolster ASP efficacy in the outpatient setting. Going forward, posters modeled off of the IDPH template will be conspicuously exhibited in exam rooms, indicating institutional commitment to the enumerated ASP guidelines. Future studies will allow for comparison of pre- and post-intervention knowledge and prescriber compliance. Disclosures All Authors: No reported disclosures

scholarly journals Outpatient Antibiotic Prescription Trends in the United States: A National Cohort Study

2018 ◽  
Vol 39 (5) ◽  
pp. 584-589 ◽  
Author(s):  
Michael J. Durkin ◽  
S. Reza Jafarzadeh ◽  
Kevin Hsueh ◽  
Ya Haddy Sallah ◽  
Kiraat D. Munshi ◽  
...  
Keyword(s):  
United States ◽  
Inappropriate Prescribing ◽  
The United States ◽  
Antibiotic Consumption ◽  
Antibiotic Prescribing ◽  
Administrative Claims ◽  
Upper Respiratory Tract ◽  
Prescribing Practices ◽  
Amoxicillin Clavulanate ◽  
Tract Infections

OBJECTIVETo characterize trends in outpatient antibiotic prescriptions in the United StatesDESIGNRetrospective ecological and temporal trend study evaluating outpatient antibiotic prescriptions from 2013 to 2015SETTINGNational administrative claims data from a pharmacy benefits manager PARTICIPANTS. Prescription pharmacy beneficiaries from Express Scripts Holding CompanyMEASUREMENTSAnnual and seasonal percent change in antibiotic prescriptionsRESULTSApproximately 98 million outpatient antibiotic prescriptions were filled by 39 million insurance beneficiaries during the 3-year study period. The most commonly prescribed antibiotics were azithromycin, amoxicillin, amoxicillin/clavulanate, ciprofloxacin, and cephalexin. No significant changes in individual or overall annual antibiotic prescribing rates were found during the study period. Significant seasonal variation was observed, with antibiotics being 42% more likely to be prescribed during February than September (peak-to-trough ratio [PTTR], 1.42; 95% confidence interval [CI], 1.39–1.61). Similar seasonal trends were found for azithromycin (PTTR, 2.46; 95% CI, 2.44–3.47), amoxicillin (PTTR, 1.52; 95% CI, 1.42–1.89), and amoxicillin/clavulanate (PTTR, 1.78; 95% CI, 1.68–2.29).CONCLUSIONSThis study demonstrates that annual national outpatient antibiotic prescribing practices remained unchanged during our study period. Furthermore, seasonal peaks in antibiotics generally used to treat viral upper respiratory tract infections remained unchanged during cold and influenza season. These results suggest that inappropriate prescribing of antibiotics remains widespread, despite the concurrent release of several guideline-based best practices intended to reduce inappropriate antibiotic consumption; however, further research linking national outpatient antibiotic prescriptions to associated medical conditions is needed to confirm these findings.Infect Control Hosp Epidemiol 2018;39:584–589

scholarly journals Antibiotic Prescribing Variability in a Large Urgent Care Network: A New Target for Outpatient Stewardship

2019 ◽  
Vol 70 (8) ◽  
pp. 1781-1787 ◽  
Author(s):  
Edward Stenehjem ◽  
Anthony Wallin ◽  
Katherine E Fleming-Dutra ◽  
Whitney R Buckel ◽  
Valoree Stanfield ◽  
...  
Keyword(s):  
The United States ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
First Line ◽  
Healthcare Network ◽  
Selection For ◽  
Intermountain Healthcare ◽  
Outpatient Settings ◽  
Respiratory Conditions

Abstract Improving antibiotic prescribing in outpatient settings is a public health priority. In the United States, urgent care (UC) encounters are increasing and have high rates of inappropriate antibiotic prescribing. Our objective was to characterize antibiotic prescribing practices during UC encounters, with a focus on respiratory tract conditions. This was a retrospective cohort study of UC encounters in the Intermountain Healthcare network. Among 1.16 million UC encounters, antibiotics were prescribed during 34% of UC encounters and respiratory conditions accounted for 61% of all antibiotics prescribed. Of respiratory encounters, 50% resulted in antibiotic prescriptions, yet the variability at the level of the provider ranged from 3% to 94%. Similar variability between providers was observed for respiratory conditions where antibiotics were not indicated and in first-line antibiotic selection for sinusitis, otitis media, and pharyngitis. These findings support the importance of developing antibiotic stewardship interventions specifically targeting UC settings.

scholarly journals 20. Fluoroquinolone and Overall Outpatient Antibiotic Prescribing Trends in Adults, 2011 to 2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S10-S11
Author(s):  
Katryna A Gouin ◽  
Laura M King ◽  
Monina Bartoces ◽  
Sarah Kabbani; Rebecca M Roberts ◽  
Sharon Tsay ◽  
...  
Keyword(s):  
United States ◽  
Older Adults ◽  
Adverse Events ◽  
Antibiotic Prescription ◽  
The United States ◽  
Antibiotic Prescribing ◽  
Age Group ◽  
Prescribing Practices ◽  
Prescribing Trends ◽  
Prescription Rates

Abstract Background Fluoroquinolones (FQs) are the third most commonly prescribed antibiotics among U.S. outpatients, and the second most commonly prescribed class among adults ≥ 65 years of age. However, FQ use has been associated with severe adverse events, especially among older adults. As a result, in 2016 the U.S. Food and Drug Administration (FDA) issued warnings against FQ use when other agents may be effective. We assessed changes in outpatient FQ prescribing relative to overall antibiotic prescribing from 2011 to 2018. Methods We estimated annual antibiotic prescription rates in adults ≥ 20 years of age for all classes and FQs using national prescription dispensing count data from IQVIA Xponent (numerator) and census estimates (denominator) for 2011 to 2018. We used Poisson models to estimate prevalence rate ratios (PRR) and 95% confidence intervals (CIs) comparing antibiotic prescription rates overall and stratified by age group from 2011 to 2018. The Chi-square test was used to compare the percent decrease in rates between age groups. Results From 2011 to 2018, prescription rates in adults for all antibiotics decreased by 2% (PRR 0.98, 95% CI: 0.98-0.98); FQ prescription rates decreased by 30% (PRR 0.70, 95% CI: 0.69–0.70), with the largest decline from 2015–2018 (Figure 1). Adults ≥ 65 years had the highest FQ prescription rates for 2011 to 2018, at a rate 2.37 (95% CI: 2.32,2.42) times that of adults 20–64 years (Figure 2). The FQ prescribing rate in adults 20–64 experienced a greater decrease from 2011 to 2018 than the rate in adults ≥ 65 years (p< 0.0001), with a 35% decrease (PRR 0.65, 95% CI: 0.65, 0.65) in adults 20–64 years compared to a 29% (PRR 0.71, 95% CI: 0.71-0.71) decrease in adults ≥ 65 years (Figure 2). Decreases in total outpatient antibiotic and fluoroquinolone prescribing rates among adults in the United States from 2011 to 2018 Decreases in outpatient fluoroquinolone prescriptions per 1,000 persons by age group in the United States from 2011 to 2018 Conclusion FQ prescribing decreased markedly compared to overall antibiotic prescribing from 2011 to 2018, which was likely due in part to FDA warnings on FQ-associated adverse events. However, FQ prescribing among older adults remained high during this period and did not decrease as much as in younger adults. Further evaluation of the diagnoses associated with prescribing may provide additional opportunities to optimize FQ prescribing practices, especially among older adults. Disclosures All Authors: No reported disclosures

scholarly journals Antibiotic prescription practices among prescribers for children under five at public health centers III and IV in Mbarara district

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243868
Author(s):  
Nelson Okello ◽  
Joseph Oloro ◽  
Catherine Kyakwera ◽  
Elias Kumbakumba ◽  
Celestino Obua
Keyword(s):  
Health Care Providers ◽  
Antibiotic Prescription ◽  
Health Centers ◽  
Upper Respiratory Tract ◽  
Care Providers ◽  
Children Under Five ◽  
Under Five ◽  
Prescription Practices ◽  
Care Facilities ◽  
Upper Respiratory

Introduction Rational use of medicines requires that patients receive medications appropriate to their clinical needs. Irrational prescription of antibiotics has been reported in many health systems across the world. In Uganda, mainly nurses and assistant medical officers (Clinical officers) prescribe for children at level III and IV primary care facilities (health center II and IV). Nurses are not primarily trained prescribers; their antibiotic prescription maybe associated with errors. There is a need to understand the practices of antibiotic prescription among prescribers in the public primary care facilities. We therefore determined antibiotic prescription practices of prescribers for children under five years at health center III and IV in Mbarara district, South Western Uganda. Methods This was a retrospective descriptive cross-sectional study. We reviewed outpatient records of children <5 years of age retrospectively. Information obtained from the outpatient registers were captured in predesigned data abstraction form. Health care providers working at health centers III and IV were interviewed using a structured questionnaire. They provided information on socio-demographic, health facility, antibiotic prescription practices and availability of reference tools. Data was analyzed using STATA software version 13∙0. Results There were 1218 outpatients records of children under five years reviewed and 35 health care providers interviewed. The most common childhood illness diagnosed was upper respiratory tract infection. It received the most antibiotic prescription (53%). The most commonly prescribed oral antibiotics were cotrimoxazole and amoxicillin, and ceftriaxone and benzyl penicillin were the commonest prescribed injectable antibiotics. Up to 68.4% of the antibiotic prescription was irrational. No prescriber or facility factors were associated with irrational antibiotic prescription practices. Conclusion Upper respiratory tract infection is the most diagnosed condition in children under five years with Cotrimoxazole and Amoxicillin being the most commonly prescribed antibiotics. Antibiotics are being prescribed irrationally at health centers III and IV in Mbarara District. Training and support supervision of prescribers at health centers III and IV in Mbarara district need to be prioritized by the district health team.

scholarly journals Appropriateness of Antibiotic Prescribing in United States Children’s Hospitals: A National Point Prevalence Survey

2020 ◽  
Vol 71 (8) ◽  
pp. e226-e234 ◽  
Author(s):  
Alison C Tribble ◽  
Brian R Lee ◽  
Kelly B Flett ◽  
Lori K Handy ◽  
Jeffrey S Gerber ◽  
...  
Keyword(s):  
United States ◽  
Antimicrobial Stewardship ◽  
Inappropriate Prescribing ◽  
The United States ◽  
Antibiotic Prescribing ◽  
Hospitalized Children ◽  
Prescribing Practices ◽  
Children's Hospitals ◽  
Stewardship Program ◽  
Children’S Hospitals

Abstract Background Studies estimate that 30%–50% of antibiotics prescribed for hospitalized patients are inappropriate, but pediatric data are limited. Characterization of inappropriate prescribing practices for children is needed to guide pediatric antimicrobial stewardship. Methods Cross-sectional analysis of antibiotic prescribing at 32 children’s hospitals in the United States. Subjects included hospitalized children with ≥ 1 antibiotic order at 8:00 am on 1 day per calendar quarter, over 6 quarters (quarter 3 2016–quarter 4 2017). Antimicrobial stewardship program (ASP) physicians and/or pharmacists used a standardized survey to collect data on antibiotic orders and evaluate appropriateness. The primary outcome was the percentage of antibiotics prescribed for infectious use that were classified as suboptimal, defined as inappropriate or needing modification. Results Of 34 927 children hospitalized on survey days, 12 213 (35.0%) had ≥ 1 active antibiotic order. Among 11 784 patients receiving antibiotics for infectious use, 25.9% were prescribed ≥ 1 suboptimal antibiotic. Of the 17 110 antibiotic orders prescribed for infectious use, 21.0% were considered suboptimal. Most common reasons for inappropriate use were bug–drug mismatch (27.7%), surgical prophylaxis &gt; 24 hours (17.7%), overly broad empiric therapy (11.2%), and unnecessary treatment (11.0%). The majority of recommended modifications were to stop (44.7%) or narrow (19.7%) the drug. ASPs would not have routinely reviewed 46.1% of suboptimal orders. Conclusions Across 32 children’s hospitals, approximately 1 in 3 hospitalized children are receiving 1 or more antibiotics at any given time. One-quarter of these children are receiving suboptimal therapy, and nearly half of suboptimal use is not captured by current ASP practices.

scholarly journals Utilizing Behavioral Science to Improve Antibiotic Prescribing in Rural Urgent Care Settings

2020 ◽  
Vol 7 (7) ◽  
Author(s):  
Patricia L Cummings ◽  
Rita Alajajian ◽  
Larissa S May ◽  
Russel Grant ◽  
Hailey Greer ◽  
...  
Keyword(s):  
Behavioral Interventions ◽  
Inappropriate Prescribing ◽  
The United States ◽  
Urgent Care ◽  
Resistant Bacteria ◽  
Antibiotic Prescribing ◽  
Intervention Period ◽  
Its Analysis ◽  
Tract Infections ◽  
Inappropriate Prescriptions

Abstract Background Antibiotic-inappropriate prescribing for acute respiratory tract infections (ARTI) is 45% among urgent care centers (UCCs) in the United States. Locally in our UCCs, antibiotic-inappropriate prescribing for ARTI is higher—over 70%. Methods We used a quasi-experimental design to implement 3 behavioral interventions targeting antibiotic-inappropriate/non-guideline-concordant prescribing for ARTI at 3 high-volume rural UCCs and analyzed prescribing rates pre- and post-intervention. The 3 interventions were (1) staff/patient education, (2) public commitment, and (3) peer comparison. For peer comparison, providers were sent feedback emails with their prescribing data during the intervention period and a blinded ranking email comparing them with their peers. Providers were categorized as “low prescribers” (ie,  ≤23% antibiotic-inappropriate prescriptions based off the US National Action Plan for Combating Antibiotic Resistant Bacteria 2020 goal) or “high prescribers” (ie,  ≥45%—the national average of antibiotic-inappropriate prescribing for ARTI). An interrupted time series (ITS) analysis compared prescribing for ARTI (the primary outcome) over a 16-month period before the intervention and during the 6-month intervention period, for a total of 22 months, across the 3 UCCs. Results Fewer antibiotic-inappropriate prescriptions were written during the intervention period (57.7%) compared with the pre-intervention period (72.6%) in the 3 UCCs, resulting in a 14.9% absolute decrease in percentage of antibiotic-inappropriate prescriptions. The ITS analysis revealed that the rate of antibiotic-inappropriate prescribing was statistically significantly different pre-intervention compared with the intervention period (95% confidence interval, –4.59 to –0.59; P = .014). Conclusions In this sample of rural UCCs, we reduced antibiotic-inappropriate prescribing for ARTI using 3 behavioral interventions.

scholarly journals 131. Antimicrobial Usage for Respiratory Infections in Urgent Care Settings within the University of Washington Medicine Network

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S77-S77
Author(s):  
Joanne Huang ◽  
Zahra Kassamali Escobar ◽  
Rupali Jain ◽  
Jeannie D Chan ◽  
John B Lynch ◽  
...  
Keyword(s):  
Adverse Drug Events ◽  
Respiratory Infections ◽  
Inappropriate Prescribing ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
University Of Washington ◽  
Tract Infections ◽  
Viral Respiratory Infections ◽  
Viral Respiratory

Abstract Background In an effort to combat antimicrobial resistance and adverse drug events, The Joint Commission mandated expansion of antimicrobial stewardship programs into ambulatory healthcare settings Jan 2020. The most common diagnoses resulting in inappropriate antimicrobial prescribing are respiratory infections. This study aimed to assess the rate of antibiotic prescribing for viral respiratory tract infections within six urgent care clinics affiliated with University of Washington Medicine health system in Seattle, WA. Methods This was a retrospective observational study from Jan 2019-Feb 2020. We used the MITIGATE toolkit; a resource that meets CDC’s core elements for outpatient stewardship. Patients were identified based upon pre-specified ICD-10 codes for viral respiratory infections. The primary outcome was the rate of unnecessary antimicrobial prescriptions for acute viral respiratory infections. Secondary outcomes evaluated inappropriate prescribing practices based on antibiotic selection, diagnosis, and age. Results Of 7,313 patients (6078 adults and 1235 pediatric) included, 23% were inappropriately prescribed antibiotics. The most common antibiotics inappropriately prescribed were azithromycin (62%), amoxicillin (13%), and doxycycline (13%). Fluoroquinolone (FQ) utilization was low (2%). Bronchitis (61%) and nonsuppurative otitis media (NSOM) (24%) were the most common viral diagnoses for which antibiotics were prescribed. Overall, unnecessary prescribing was lower in pediatrics than adults at 13% and 25%, respectively (p&lt; 0.001). Adults were more often prescribed antibiotics inappropriately for bronchitis and NSOM compared to pediatrics (p=0.0013). Conclusion Inappropriate prescribing practices across six urgent care clinics varied based upon age and diagnosis. Azithromycin is most often inappropriately prescribed but the low rate of FQ prescribing is encouraging. The lower rate of unnecessary prescribing in pediatrics is promising although there is room for improvement as 1 in 8 children were unnecessarily prescribed antibiotics. These findings support the need for antibiotic stewardship in the outpatient setting, targeting areas for azithromycin use and therapeutic management of bronchitis. Disclosures All Authors: No reported disclosures

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

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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