scholarly journals 1958. Assessment of Guideline-Concordant Antimicrobial Prescribing in Urgent Care Centers

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S62-S62
Author(s):  
Janet Wu ◽  
Kaitlyn R Rivard ◽  
Elizabeth A Neuner ◽  
Vasilios Athans ◽  
Camille Sabella ◽  
...  
Keyword(s):  
Otitis Media ◽  
Pediatric Patients ◽  
Respiratory Infections ◽  
Acute Bronchitis ◽  
The United States ◽  
Adult Patients ◽  
Urgent Care ◽  
Antimicrobial Prescribing ◽  
Amoxicillin Clavulanate ◽  
Urgent Care Centers

Abstract Background In the United States in 2014, 266 million outpatient antibiotic prescriptions were dispensed. The Center for Disease Control and Prevention estimates that 30% of outpatient antibiotic prescriptions are inappropriate. These inappropriate prescriptions contribute to increased resistance, adverse events, and healthcare costs. Methods This was a retrospective study of patients presenting to 22 urgent care centers within a large healthcare system between September 1, 2018 and February 28, 2019. Data were collected from a dashboard designed to track antimicrobial prescribing data by indication, location, and provider. ICD-9 and -10 codes associated with otitis media, pharyngitis, sinusitis, cystitis, and upper respiratory infections (URI) were included. Guideline-concordant antimicrobial prescribing was determined based on compliance with national guideline recommendations, after taking patient allergies into account. The URI category includes disease states in which antimicrobials are rarely appropriate (e.g., acute rhinitis, nasopharyngitis, and acute bronchitis). Results A total of 57,799 encounters were included in this analysis (19,242 pediatric and 38,557 adult) and 60% of patients received an antibiotic prescription. Overall antimicrobial guideline concordance was higher in pediatrics (84%) than adults (62%). Rates of guideline-concordant antimicrobial selection are shown in Table 1. The most common guideline-discordant prescriptions were tetracyclines (39%), amoxicillin/clavulanate (26%), and macrolides (17%) in adult patients with sinusitis, pharyngitis, or otitis media. In pediatric patients, the most common discordant prescriptions were macrolides (32%), third-generation cephalosporins (30%), and amoxicillin/clavulanate (19%). Unnecessary antimicrobial prescribing for URI occurred in 23% of pediatric patients and 36% of adult patients. Conclusion Guideline-discordant antimicrobial prescribing is common in urgent care centers, particularly in adult patients. In addition to encouraging utilization of order sets, emphasis on education and feedback may be important to improve and sustain guideline-concordant prescribing rates and reduce prescribing for URI. Disclosures All Authors: No reported Disclosures.

scholarly journals Respiratory Infection and Antimicrobial Prescribing: How Well Are the Guidelines Adhered To?

2015 ◽  
Author(s):  
Veronica Seippel
Keyword(s):  
Respiratory Infections ◽  
Care Facility ◽  
The United States ◽  
Urgent Care ◽  
Advanced Practice ◽  
Star Model ◽  
Practice Nurses ◽  
Antimicrobial Prescribing ◽  
Prescribing Trends ◽  
Made In

<p>Approximately two million people in the United States (US) are infected annually by organisms that have developed resistance to one or more of the antimicrobials designed to eradicate them. The highest-ranking category of illness for which antibiotics are most commonly overprescribed is respiratory infections (CDC, 2014a). The purpose of this project was to explore current antimicrobial prescribing trends for respiratory infections at an urgent care facility. The ACE Star Model of Knowledge Transformation (Stevens, 2004) was utilized to serve as a guide in conducting this research study. Utilizing the detailed guidelines and treatment criteria for respiratory infections developed by the American College of Chest Physicians, a determination regarding the appropriateness of treatment was made. In this study, the rate of overprescribing at the study site was found to be approximately 22.66% as compared to the national average of 50% (CDC, 2013). Calculating the current prescribing trends and overprescribing rates is the first step in acknowledging the issue within this particular setting. Much more progress needs to be made to address methods and strategies for resolution including the adaptation of a modified antimicrobial stewardship applicable to ambulatory/urgent care settings Regardless of how the resolution to this worldwide problem will come about, it will not happen without multi-disciplinary cooperation. Advanced practice nurses are in a unique position to be able to act as leaders and educators regarding this issue.</p>

scholarly journals Association of Receipt of Antibiotics with Patient Satisfaction for Caregivers of Children Presenting to Urgent-Care Settings

2020 ◽  
Vol 41 (S1) ◽  
pp. s134-s135
Author(s):  
Diane Liu ◽  
NORA FINO ◽  
Benjamin Haaland ◽  
Adam Hersh ◽  
Emily Thorell ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Otitis Media ◽  
Respiratory Infections ◽  
Otitis Media With Effusion ◽  
Multivariable Analysis ◽  
Acute Otitis Media ◽  
Skewed Distribution ◽  
Urgent Care ◽  
Provider Type ◽  
Patient Dissatisfaction

Background: The Press Ganey (PG) Medical Practice Survey is a commonly used questionnaire for measuring patient experience in healthcare. Our objective was to evaluate the PG surveys completed by caregivers of children presenting for urgent care evaluation of acute respiratory infections (ARIs) to determine any correlation with receipt of antibiotics during their visit. Methods: We evaluated responses to the PG urgent-care surveys for encounters of children <18 years presenting with ARIs (ie, sinusitis, bronchitis, pharyngitis, upper respiratory infection, acute otitis media, or serous otitis media with effusion) within 9 University of Utah urgent-care centers. Scores could range from 0 to 100. Because the distributions of scores followed right- skewed distribution with a high ceiling effect, we defined scores as dissatisfied with their care (≤25th percentile) and satisfied with their care (scores >25th percentile). Univariate and multivariable generalized mixed-effects logistic regression was used to assess correlates of patient dissatisfaction. Random intercepts were included for each provider to account for correlation within the same provider. Separate models were used for each PG component score. Multivariable models adjusted for receipt of antibiotics, age, gender, race, ethnicity, and provider type. Results: Overall, 388 of 520 responses (74.6%) indicated satisfaction and 132 responses (25.4%) indicated dissatisfaction. Among patients who did not receive antibiotics, 87 of 284 responses (30.6%) indicated dissatisfaction versus 45 of 236 (19.1%) who did receive antibiotics. Among patients who were dissatisfied with their clinician, raw clinician PG scores were higher among patients who received antibiotics (mean, 64.5; standard deviation [SD], 16.9) versus those who did not receive antibiotics (mean, 54.7; SD, 24.4; P = .015) (Table 1). In a multivariable analysis, receipt of antibiotics was associated with a reduction in patient dissatisfaction overall (odds ratio, 0.55; 95% CI, 0.36–0.85). Conclusions: Overall, most responses for patients seen for ARIs in pediatric urgent care were satisfied. However, a significantly higher proportion of responses for patients who did not receive antibiotics were dissatisfied than for those patients who received antibiotics. Antibiotic stewardship strategies to communicate appropriate prescribing while preserving patient satisfaction are needed in pediatric urgent-care settings.Funding: NoneDisclosures: None

Urgent Care Centers Delay Emergent Surgical Care Based on Patient Insurance Status in The United States

2020 ◽  
Vol 272 (4) ◽  
pp. 548-553
Author(s):  
Walter R. Hsiang ◽  
Daniel Wiznia ◽  
Laurie Yousman ◽  
Michael Najem ◽  
Alison Mosier-Mills ◽  
...  
Keyword(s):  
United States ◽  
Surgical Care ◽  
The United States ◽  
Urgent Care ◽  
Insurance Status ◽  
Urgent Care Centers

scholarly journals Guideline Adherence and Antibiotic Utilization by Community Pediatricians, Private Urgent Care Centers, and a Pediatric Emergency Department

2019 ◽  
Vol 59 (1) ◽  
pp. 21-30 ◽  
Author(s):  
Shamim Islam ◽  
Mary Kathryn Mannix ◽  
Ryan K. Breuer ◽  
Amanda B. Hassinger
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
New York ◽  
Otitis Media ◽  
Pediatric Emergency ◽  
Urgent Care ◽  
Medical Society ◽  
Pediatric Emergency Department ◽  
Antibiotic Utilization ◽  
Urgent Care Centers

Pediatric antibiotic prescriptions originate from an increasingly broad range of ambulatory settings. In this retrospective study, pharyngitis, otitis media, sinusitis, pneumonia, and upper respiratory infection cases, at 11 primary care offices, 2 independent urgent care centers (UCCs), and a pediatric emergency department in Western New York, were analyzed relative to medical society practice guidelines and antibiotic utilization. Of 2358 eligible visits across all sites, 25% were for study diagnoses, with 38% at UCC ( P < .01). Across all sites, 26% of pharyngitis cases given antibiotics did not have diagnostic evidence of bacterial infection. At primary care offices and UCCs, guideline recommended first-line agents for pharyngitis and otitis media were used in only 58% and 63% of treated cases, respectively. Overall, an estimated 9855 to 12 045 avoidable antibiotic and 8030 non-guideline antibiotic courses annually are represented by the 14 sites studied. These and other study findings highlight numerous opportunities for outpatient pediatric antibiotic stewardship.

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