94. Implementation of Antibiotic Prescribing Scorecards in the Ambulatory Care Setting

Abstract Background Up to 56% of antibiotics prescribed in the ambulatory setting in the United States are inappropriately prescribed, with 30% of those determined to be unnecessary. In order to increase transparency and education about antibiotic prescribing in our ambulatory clinics at our institution, we implemented quarterly scorecards demonstrating antibiotic prescribing trends for primary care prescribers. Methods This pre-post interventional study analyzed the impact of prescriber scorecards on antibiotic prescribing, with the intervention consisting of real-time education and presentation of baseline data via scorecards. Prescribers were educated on the scorecard project via live meetings in Nov-Dec 2020. In Dec 2020, prescribers were sent individual emails describing their baseline antibiotic prescription rate (defined as number of prescriptions per 100 patient encounters), de-identified comparison data for other prescribers within their individual clinic, and average rate of the top 10% of prescribers with the lowest prescription rates. Baseline data was from prescriptions dated Jan-Mar 2020. The email also explained the project and shared that quarterly scorecards would be distributed in 2021. Baseline data was compared to prescription data from Jan-Mar 2021. Knowing the COVID-19 pandemic resulted in significantly fewer encounters for respiratory infections, data was also analyzed with respiratory diagnoses removed from the dataset. Results In the pre-intervention period, 11,769 antibiotics were prescribed during 92,239 encounters for a prescription rate of 12.8 (95%CI: 12.5-13.0). Of 96,449 encounters in the post-intervention period, 7,326 antibiotics were prescribed for a rate of 7.6 (95%CI: 7.4-7.8; p< 0.0001). When respiratory diagnoses were removed, prescription rates were 6.1 (95%CI: 5.9-6.2) in the pre-group, compared to 6.3 (95%CI: 6.1-6.5; p=0.0546). When analyzed by prescriber, significant decreases were seen in prescriptions by physicians (5.8 vs 5.4, p=0.0035) while increases were seen in prescriptions by advanced practice prescribers. Conclusion Antibiotic scorecards sent to prescribers may result in reduced antibiotic prescribing, but further research is needed to elucidate the impact of the scorecards in light of the COVID-19 pandemic. Disclosures All Authors: No reported disclosures

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218. Changes in Dental Antibiotic Prescribing in the United States, 2012–2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.262 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S111-S111

Author(s):

Swetha Ramanathan ◽

Connie H Yan ◽

Colin Hubbard ◽

Gregory Calip ◽

Lisa K Sharp ◽

...

Keyword(s):

The United States ◽

Cross Sectional Study ◽

Antibiotic Prescribing ◽

Prescription Data ◽

Oral Antibiotic ◽

Sectional Study ◽

Cross Sectional ◽

Prescribing Trends ◽

Adults And Children ◽

Linear Regressions

Abstract Background Data suggest dental antibiotic prescribing is increasing with relatively less documented about prescribing trends in adults and children. Therefore, the aim was to evaluate trends in antibiotic prescribing by US dentists from 2012–2017. Methods This was a cross-sectional study of US dental prescribing using IQVIA Longitudinal Prescription Data from 2012 to 2017. Prescribing rates (prescriptions [Rx] per 100,000 dentists), mean days’ supply, and mean quantity dispensed were calculated monthly across eight oral antibiotic groups: amoxicillin, clindamycin, cephalexin, azithromycin, penicillin, doxycycline, fluoroquinolone, and other antibiotics. Descriptive frequencies and multiple linear regressions were performed to obtain trends overall and stratified by adults (≥ 18) and children (< 18). Results 220, 325 dentists prescribed 135 million Rx (94.0% in adults). 61.0% were amoxicillin, 14.4% clindamycin, 11.7% penicillin, 4.4% azithromycin, 4.3% cephalexin, 2.0% other antibiotics, 1.4% doxycycline, and 0.7% fluoroquinolones. Prescribing increased by 33 Rx/100,000 dentists (p< 0.0001) each month for all antibiotics. Amoxicillin (p< 0.0001) and clindamycin (p=0.02) prescribing rate increased by 73 and 5 Rx/100,000 dentists, respectively. Prescribing decreased by 8, 12, and 2 Rx/100,000 dentists for cephalexin (p< 0.0001), doxycycline (p< 0.0001), and fluoroquinolones (p=0.008), respectively. Mean days’ supply increased for amoxicillin, penicillin, and clindamycin (p< 0.0001), and decreased for cephalexin (p< 0.0001).Mean quantity dispensed decreased (p< 0.0001) for all groups except azithromycin and doxycycline. Among adults, cephalexin prescribing rates (7 Rx/100,000 dentist; p< 0.0001) and other antibiotics days’ supply (p< 0.0001) decreased. Among children, azithromycin prescribing rates (1 Rx/100,000 dentists, p=0.02), and fluoroquinolone and other antibiotics days’ supply (p< 0.0001) decreased. Conclusion These findings support dental antibiotic prescribing is increasing, specifically for amoxicillin and clindamycin. Further, trends differed between adults and children. Understanding what is driving these trends is important to target dental antibiotic stewardship efforts. Disclosures All Authors: No reported disclosures

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa417.019 ◽

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

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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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Clinical impact of pharmacist-led antibiotic stewardship programs in outpatient settings in the United States: A scoping review

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxab178 ◽

2021 ◽

Author(s):

James St. Louis ◽

Arinze Nkemdirim Okere

Keyword(s):

United States ◽

Usual Care ◽

Antibiotic Stewardship ◽

The United States ◽

Controlled Trials ◽

Antibiotic Prescribing ◽

Successful Implementation ◽

Pharmacist Interventions ◽

Outpatient Settings ◽

The Impact

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To provide an overview of the impact of pharmacist interventions on antibiotic prescribing and the resultant clinical outcomes in an outpatient antibiotic stewardship program (ASP) in the United States. Methods Reports on studies of pharmacist-led ASP interventions implemented in US outpatient settings published from January 2000 to November 2020 and indexed in PubMed or Google Scholar were included. Additionally, studies documented at the ClinicalTrials.gov website were evaluated. Study selection was based on predetermined inclusion criteria; only randomized controlled trials, observational studies, nonrandomized controlled trials, and case-control studies conducted in outpatient settings in the United States were included. The primary outcome was the observed differences in antibiotic prescribing or clinical benefits between pharmacist-led ASP interventions and usual care. Results Of the 196 studies retrieved for full-text review, a cumulative total of 15 studies were included for final evaluation. Upon analysis, we observed that there was no consistent methodology in the implementation of ASPs and, in most cases, the outcome of interest varied. Nonetheless, there was a trend toward improvement in antibiotic prescribing with pharmacist interventions in ASPs compared with that under usual care (P < 0.05). However, the results of these studies are not easily generalizable. Conclusion Our findings suggest a need for a consistent approach for the practical application of outpatient pharmacist-led ASPs. Managed care organizations could play a significant role in ensuring the successful implementation of pharmacist-led ASPs in outpatient settings.

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The Impact of the COVID-19 Pandemic on Antibiotic Prescribing Trends in Outpatient Care: A Nationwide, Quasi-Experimental Approach

Antibiotics ◽

10.3390/antibiotics10091040 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1040

Author(s):

Tânia Magalhães Silva ◽

Marta Estrela ◽

Eva Rebelo Gomes ◽

Maria Piñeiro-Lamas ◽

Adolfo Figueiras ◽

...

Keyword(s):

Public Health ◽

Outpatient Care ◽

Experimental Approach ◽

National Level ◽

Series Data ◽

Antibiotic Prescribing ◽

Prescribing Trends ◽

Quasi Experimental ◽

The Impact

Coronavirus disease 2019 (COVID-19) has spread globally and is currently having a damaging impact on nearly all countries in the world. The implementation of stringent measures to stop COVID-19 dissemination had an influence on healthcare services and associated procedures, possibly causing antibiotic consumption fluctuations. This paper aims to evaluate the immediate and long-term impact of the COVID-19 pandemic on antibiotic prescribing trends in outpatient care of the Portuguese public health sector, including in primary healthcare centers and hospitals, as well as on specific antibiotic groups known to be closely associated with increased resistance. Segmented regression analysis with interrupted time series data was used to analyze whether the COVID-19 pandemic had an impact in antibiotic prescribing tendencies at a national level. The outcomes from this quasi-experimental approach demonstrate that, at the beginning of the pandemic, a significant, immediate decrease in the overall antibiotic prescribing trends was noticed in the context of outpatient care in Portugal, followed by a statistically non-significant fall over the long term. The data also showed a significant reduction in the prescription of particular antibiotic classes (antibiotics from the Watch group, 3rd-generation cephalosporins, fluoroquinolones, and clarithromycin) upon COVID-19 emergence. These findings revealed an important disruption in antibiotics prescribing caused by the current public health emergency.

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Impact of the COVID-19 pandemic on community antibiotic prescribing in Scotland

JAC-Antimicrobial Resistance ◽

10.1093/jacamr/dlaa105 ◽

2020 ◽

Vol 2 (4) ◽

Author(s):

William Malcolm ◽

Ronald A Seaton ◽

Gail Haddock ◽

Linsey Baxter ◽

Sarah Thirlwell ◽

...

Keyword(s):

Respiratory Infections ◽

Age Groups ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Prescription Data ◽

National Data ◽

Time Data ◽

Electronic Messaging ◽

The Impact ◽

Selection Of

Abstract Background Following concerns about increased antibiotic use during the COVID-19 pandemic, trends in community antibiotic prescriptions in Scotland were evaluated. Methods The primary care prescription electronic messaging system used in GP practices with NHS contracts provided near real-time data analysis of national data. The main outcome measures were the weekly number of prescriptions for antibiotics generated by prescribers in GP practices in 2020 compared with 2019. Results At end of Week 12 2020 (22 March), after a sharp increase, the number of prescriptions commonly used for respiratory infections was 44% higher than the corresponding week in 2019. The number of prescriptions for respiratory antibiotics reduced through April and May 2020, with 34% fewer prescriptions issued by end of Week 22 (31 May) than in the corresponding week in 2019. Reductions were pronounced in all age groups but particularly apparent for prescriptions for children aged 0–4 years. These data were compared with weekly prescriptions for a selection of non-respiratory antibiotics and no difference was seen between 2020 and 2019. Conclusions Trends in antibiotic prescription data show that after an initial surge, and following ‘lockdown’ in Scotland, the total number of prescriptions for antibiotics commonly used for respiratory infections fell. We believe this is the first published national evaluation of the impact of COVID-19 on community use of antibiotics. Further analysis of national data is planned to provide a greater understanding of the reasons behind these trends.

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Influence of Obesity on Surgical Regional Anesthesia in the Ambulatory Setting: An Analysis of 9,038 Blocks

Anesthesiology ◽

10.1097/00000542-200501000-00027 ◽

2005 ◽

Vol 102 (1) ◽

pp. 181-187 ◽

Cited By ~ 104

Author(s):

Karen C. Nielsen ◽

Ulrich Guller ◽

Susan M. Steele ◽

Stephen M. Klein ◽

Roy A. Greengrass ◽

...

Keyword(s):

Postoperative Pain ◽

Regional Anesthesia ◽

The United States ◽

Ambulatory Setting ◽

Efficacy Rate ◽

Complication Rates ◽

Obese Patients ◽

Acute Complications ◽

Pain At Rest ◽

The Impact

Background Regional anesthesia is increasing in popularity for ambulatory surgical procedures. Concomitantly, the prevalence of obesity in the United States population is increasing. The objective of the present investigation was to assess the impact of body mass index (BMI) on patient outcomes after ambulatory regional anesthesia. Methods This study was based on prospectively collected data including 9,038 blocks performed on 6,920 patients in a single ambulatory surgery center. Patients were categorized into three groups according to their BMI (<25 kg/m2, 25-29 kg/m2, > or =30 kg/m2). Block efficacy, rate of acute complications, postoperative pain (at rest and with movement), postoperative nausea and vomiting, rate of unscheduled hospital admissions, and overall patient satisfaction were assessed. Linear and logistic multivariable analyses were used to obtain the risk-adjusted effect of BMI on these outcomes. Results Of all patients 34.8% had a BMI <25 kg/m2, 34.0% were overweight (BMI 25-29 kg/m2), and 31.3% were obese (BMI > or = 30 kg/m2). Patients with BMI > or =30 kg/m2 were 1.62 times more likely to have a failed block (P = 0.04). The unadjusted rate of acute complications was higher in obese patients (P = 0.001). However, when compared with patients with a normal BMI, postoperative pain at rest, unanticipated admissions, and overall satisfaction were similar in overweight and obese patients. Conclusions The present investigation shows that obesity is associated with higher block failure and complication rates in surgical regional anesthesia in the ambulatory setting. Nonetheless, the rate of successful blocks and overall satisfaction remained high in patients with increased BMI. Therefore, overweight and obese patients should not be excluded from regional anesthesia procedures in the ambulatory setting.

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Somewhere to go: Assessing the impact of public restroom interventions on reports of open defecation in San Francisco, California from 2014 to 2020

10.21203/rs.3.rs-936620/v1 ◽

2021 ◽

Author(s):

Heather Kathleen Amato ◽

Douglas Martin ◽

Christopher Michael Hoover ◽

Jay Paul Graham

Keyword(s):

Public Health ◽

San Francisco ◽

Fecal Contamination ◽

The United States ◽

Public Health Issue ◽

Intervention Period ◽

Interrupted Time Series Analysis ◽

Post Intervention ◽

Open Defecation ◽

The Impact

Abstract Background Open defecation due to a lack of access to sanitation facilities remains a public health issue in the United States. People experiencing homelessness face barriers to accessing sanitation facilities, and are often forced to practice open defecation on streets and sidewalks. Exposed feces may contain harmful pathogens posing a significant threat to public health, especially among unhoused persons living near open defecation sites. The City of San Francisco’s Department of Public Works implemented the Pit Stop Program to provide the unhoused and the general public with improved access to sanitation with the goal of reducing fecal contamination on streets and sidewalks. The objective of this study was to assess the impact of these public restroom interventions on reports of exposed feces in San Francisco, California. Methods We evaluated the impact of various public restroom interventions implemented from January 1, 2014 to January 1, 2020 on reports of exposed feces, captured through a 311 municipal service. Publicly available 311 reports of exposed feces were spatially and temporally matched to 31 Pit Stop restroom interventions in ten San Francisco neighborhoods. We conducted an interrupted time-series analysis to compare pre- versus post-intervention rates of feces reports near the restrooms. Results Feces reports declined by 12.47 reports per week after the installation of 13 Pit Stop restrooms (p-value = 0.0002). The rate of reports per week declined from the six-month pre-intervention period to the post-intervention period (slope change=-0.024 [95% CI=-0.033, -0.014]). Reports also declined after new restroom installations in the Mission and Golden Gate Park, and after the provision of attendants in the Mission, Castro/Upper Market, and Financial District/South Beach. Conclusions Increased access to public toilets and the addition of restroom attendants reduced fecal contamination in San Francisco, especially in neighborhoods with people experiencing homelessness. Programs that improve access to public restrooms should be evaluated at the neighborhood level in order to tailor sanitation interventions to neighborhood-specific needs.

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Changing antibiotic prescribing practices in outpatient primary care settings in China: Study protocol for a health information system-based cluster-randomised crossover controlled trial

PLoS ONE ◽

10.1371/journal.pone.0259065 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0259065

Author(s):

Yue Chang ◽

Yuanfan Yao ◽

Zhezhe Cui ◽

Guanghong Yang ◽

Duan Li ◽

...

Keyword(s):

Primary Care ◽

Antibiotic Prescription ◽

Intervention Group ◽

Control Group ◽

Antibiotic Prescribing ◽

Prescription Rate ◽

Feedback Intervention ◽

Primary Care Settings ◽

Cluster Randomised ◽

Prescription Rates

Background The overuse and abuse of antibiotics is a major risk factor for antibiotic resistance in primary care settings of China. In this study, the effectiveness of an automatically-presented, privacy-protecting, computer information technology (IT)-based antibiotic feedback intervention will be evaluated to determine whether it can reduce antibiotic prescribing rates and unreasonable prescribing behaviours. Methods We will pilot and develop a cluster-randomised, open controlled, crossover, superiority trial. A total of 320 outpatient physicians in 6 counties of Guizhou province who met the standard will be randomly divided into intervention group and control group with a primary care hospital being the unit of cluster allocation. In the intervention group, the three components of the feedback intervention included: 1. Artificial intelligence (AI)-based real-time warnings of improper antibiotic use; 2. Pop-up windows of antibiotic prescription rate ranking; 3. Distribution of educational manuals. In the control group, no form of intervention will be provided. The trial will last for 6 months and will be divided into two phases of three months each. The two groups will crossover after 3 months. The primary outcome is the 10-day antibiotic prescription rate of physicians. The secondary outcome is the rational use of antibiotic prescriptions. The acceptability and feasibility of this feedback intervention study will be evaluated using both qualitative and quantitative assessment methods. Discussion This study will overcome limitations of our previous study, which only focused on reducing antibiotic prescription rates. AI techniques and an educational intervention will be used in this study to effectively reduce antibiotic prescription rates and antibiotic irregularities. This study will also provide new ideas and approaches for further research in this area. Trial registration ISRCTN, ID: ISRCTN13817256. Registered on 11 January 2020.

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2067. Improving Outpatient Antimicrobial Prescribing for Respiratory Tract Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1747 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S696-S697

Author(s):

Lauren S Dutcher ◽

Kathleen Degnan ◽

Ebbing Lautenbach ◽

David A Pegues ◽

Michael Z David ◽

...

Keyword(s):

Respiratory Tract ◽

Respiratory Tract Infections ◽

Primary Diagnosis ◽

Ambulatory Setting ◽

Antibiotic Prescribing ◽

Stepped Wedge ◽

Antimicrobial Prescribing ◽

Tract Infections ◽

Tier 3 ◽

The Impact

Abstract Background Antimicrobial stewardship often focuses on inpatients, yet inappropriate antimicrobial use is common in the outpatient setting. We performed a prospective, stepped wedge interventional study to assess the impact of an educational and feedback-based intervention on prescribing practices for respiratory tract infections (RTIs) in the adult primary care ambulatory setting. Methods Family and internal medicine practices were randomly placed into 6 cohorts, which received the intervention in a stepped wedge fashion at monthly intervals. The study period was July 1, 2016 to October 31, 2018, with the intervention occurring from October 1, 2017 to October 31, 2018. The intervention consisted of a 20-minute in-person educational session on appropriate antimicrobial prescribing for RTIs followed by monthly feedback to individual providers on their proportion of antibiotic prescriptions in comparison to their peers for (1) visits with a primary diagnosis of any RTI and (2) visits with a primary diagnosis of an RTI for which an antibiotic should rarely be prescribed (tier 3 diagnoses). The outcome of interest was whether an antibiotic was prescribed in RTI visits. Chi squared testing and logistic regression were used for analysis. Results Thirty-two practices participated, with 197,814 unique visits with a primary RTI diagnosis. Of these, 141,888 (71.7%) were physician visits and 55,926 (28.3%) were advanced practitioner visits (Figure 1). The proportion of visits with antibiotic prescriptions dropped from 37.2% to 24.0% following the intervention (P < 0.0001). Antibiotic prescriptions were significantly reduced for all primary RTI visits, OR 0.53 (95% CI 0.52 to 0.54), as well as for visits with tier 3 RTI diagnoses, OR 0.64 (95% CI 0.60 to 0.68). The proportion of visits with antibiotic prescriptions also exhibited a marked seasonal variation, another finding of the study (Figure 2). Conclusion An educational intervention with provider feedback successfully reduced antibiotic prescribing for RTIs in the ambulatory setting. Additional study is necessary to assess the sustainability of response over time after discontinuation of the monthly feedback. Disclosures All authors: No reported disclosures.

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