Differences in antibiotic prescriptions between direct-to-consumer telehealth and telehealth in the emergency department

2021 ◽  
pp. 1357633X2110349
Author(s):  
Peter Yao ◽  
Kriti Gogia ◽  
Sunday Clark ◽  
Hanson Hsu ◽  
Rahul Sharma ◽  
...  
Keyword(s):  
Emergency Department ◽  
Confidence Interval ◽  
Respiratory Infection ◽  
Antibiotic Stewardship ◽  
Odds Ratio ◽  
Acute Respiratory Infection ◽  
Respiratory Infections ◽  
Antibiotic Prescribing ◽  
Acute Respiratory Infections ◽  
Direct To Consumer

Background Telemedicine, which allows physicians to assess and treat patients via real-time audiovisual conferencing, is a rapidly growing modality for providing medical care. Antibiotic stewardship is one important measure of care quality, and research on antibiotic prescribing for acute respiratory infections in direct-to-consumer telemedicine has yielded mixed results. We compared antibiotic prescription rates for acute respiratory infections in two groups treated by telemedicine: (1) patients treated via a direct-to-consumer telemedicine application and (2) patients treated via telemedicine while physically inside the emergency department. Methods We included direct-to-consumer telemedicine and emergency department telemedicine visits for patients 18 years and older with physician-coded International Classification of Diseases, Tenth Revision acute respiratory infection diagnoses between November 2016 and December 2018. Patients in both groups were seen by the same emergency department faculty working dedicated telemedicine shifts. We compared antibiotic prescribing rates for direct-to-consumer telemedicine and emergency department telemedicine visits before and after adjustment for age, sex, and diagnosis. Results We identified a total of 468 acute respiratory infection visits: 191 direct-to-consumer telemedicine visits and 277 emergency department telemedicine visits. Overall, antibiotics were prescribed for 47% of visits (59% of direct-to-consumer telemedicine visits vs 39% of emergency department telemedicine visits; odds ratio 2.23; 95% confidence interval 1.53–3.25; P < 0.001). The difference in antibiotic prescribing rates remained significant after adjustment for age, sex, and diagnosis (odds ratio 2.49; 95% confidence interval 1.65–3.77; P < 0.001). Conclusion Patients seen by the same group of physicians for acute respiratory infection were significantly more likely to be prescribed antibiotics by direct-to-consumer telemedicine care compared with telemedicine care in the emergency department. This work suggests that contextual factors rather than evaluation over video may contribute to differences in antibiotic stewardship for direct-to-consumer telemedicine encounters.

A model for improving and assessing outpatient stewardship initiatives for acute respiratory infection

2019 ◽  
Vol 40 (10) ◽  
pp. 1198-1200 ◽  
Author(s):  
Joan Guzik ◽  
Pooja Kothari ◽  
Misha Sharp ◽  
Belinda Ostrowsky ◽  
Gopi Patel ◽  
...  
Keyword(s):  
Healthcare System ◽  
Respiratory Infection ◽  
Antibiotic Stewardship ◽  
Acute Respiratory Infection ◽  
Respiratory Infections ◽  
Acute Respiratory Infections ◽  
New Yorker ◽  
Stage 1

Many hospitals have established inpatient antibiotic stewardship programs (ASPs), but outpatient activities remain limited. In 2016, the United Hospital Fund (UHF), an independent nonprofit working to build a more effective healthcare system for every New Yorker, launched a 2-stage grant-funded initiative to evaluate outpatient antibiotic stewardship, focusing on adults with acute respiratory infections (ARIs). Conclusions from stage 1 included few outpatient antibiotic stewardship activities, variation in prescribing, macrolides as the most commonly prescribed antibiotic, and provider interest in improving prescribing.1

scholarly journals An antibiotic stewardship programme to reduce inappropriate antibiotic prescribing for acute respiratory infections in rural Chinese primary care facilities: study protocol for a clustered randomised controlled trial

2020 ◽  
Author(s):  
Chao Zhuo ◽  
Xiaolin Wei ◽  
Zhitong Zhang ◽  
Joseph Paul Hicks ◽  
Jinkun Zheng ◽  
...  
Keyword(s):  
Primary Care ◽  
Antibiotic Stewardship ◽  
Respiratory Infections ◽  
Inappropriate Prescribing ◽  
Antibiotic Prescribing ◽  
Acute Respiratory Infections ◽  
Care Facilities ◽  
Randomised Controlled ◽  
Antibiotic Stewardship Programme

Abstract Background: Inappropriate prescribing of antibiotics for acute respiratory infections at primary care level represents the major source of antibiotic misuse in healthcare, and is a major driver for antimicrobial resistance worldwide. In this study we will develop, pilot and evaluate the effectiveness of a comprehensive antibiotic stewardship programme in China’s primary care hospitals to reduce inappropriate prescribing of antibiotics for acute respiratory infections among all ages.Methods: We will use a parallel-group, cluster-randomised, controlled, superiority trial with blinded outcome evaluation but unblinded treatment (providers and patients). We will randomise 34 primary care hospitals from two counties within Guangdong province into the intervention and control arm (1:1 overall ratio) stratified by county (8:9 within-county ratio). In the control arm, antibiotic prescribing and management will continue through usual care. In the intervention arm, we will implement an antibiotic stewardship programme targeting family physicians and patients/caregivers. The family physician components include: 1) training using new operational guidelines, 2) improved management and peer-review of antibiotic prescribing, 3) improved electronic medical records and smart phone app facilitation. The patient/caregiver component involves patient education via family physicians, leaflets and videos. The primary outcome is the proportion of prescriptions for acute respiratory infections (excluding pneumonia) that contain any antibiotic(s). Secondary outcomes will address how frequently specific classes of antibiotics are prescribed, how frequently key non-antibiotic alternatives are prescribed and the costs of consultations. We will conduct a qualitative process evaluation to explore operational questions regarding acceptability, cultural appropriateness and burden of technology use, as well as a cost-effectiveness analysis and a long-term benefit evaluation. The duration of the intervention will be 12 months, with another 24 months post-trial long-term follow-up.Discussion: Our study is one of the first trials to evaluate the effect of an antibiotic stewardship programme in primary care settings in a low- or middle-income country (LMIC). All intervention activities will be designed to be embedded into routine primary care with strong local ownership. Through the trial we intend to impact on clinical practice and national policy in antibiotic prescription for primary care facilities in rural China and other LMICs.Trial registration: ISRCTN, ISRCTN96892547. Registered 18 August 2019, http://www.isrctn.com/ISRCTN96892547

scholarly journals ANALISIS FAKTOR RISIKO KEJADIAN ISPA DITINJAU DARI STATUS RUMAH DI WILAYAH KERJA PUSKESMAS KOTA WILAYAH UTARA KOTA KEDIRI

IKESMA ◽  
2017 ◽  
Vol 13 (1) ◽  
Author(s):  
Ema Mayasari
Keyword(s):  
Public Health ◽  
Respiratory Infection ◽  
Physical Condition ◽  
Acute Respiratory Infection ◽  
Respiratory Infections ◽  
Health Centers ◽  
Dominant Factor ◽  
Acute Respiratory Infections ◽  
Floor Area ◽  
Home Ventilation

Acute Respiratory Infections (ARI) is one of the most common causes of death in children of developing countries. The cause of ARI include home building materials made of asbestos, has a floor with a thickness of less than 20cm and has a floor area of less than 10% of the floor area. The objective of this study was to determine the effect of physical condition to Acute Respiratory Infections (ARI) at public health centers in the region of the northern town of Kediri.This study was an analyticstudy with cross-sectional approach. There were 102 samples on society at public health centers in the region of the northern town of Kediri, and use simple random sampling. The independent variable is the building constructures, the type of floor, and size of ventilation, while the dependent variable was the incident of Acute Respiratory Infection. Data were analyzed by logistic regression.The results showed that, p value = 0,000 <a =0,05, so there is physical condition home has affected the occurrence ARI. While the most dominant factor of the three factors is size of ventilation where the value of Exp (B) 0,014 more than the other two factors, are building contructure where the value Exp (B) 0,012 and the type of floor where the value Exp (B) 0,010.The majority of respondents suffering from ARI and most the of respondent have a home ventilation that does not qualify, therefore people should pay more attention to the ventilation of their homes so spacious home ventilation of at least 10 % of their floor area. Keywords: Acute Respiratory Infection, Building Material, Floor, Ventilation

scholarly journals Antibiotic prescribing for acute respiratory infections in New York City: A model for collaboration

2018 ◽  
Vol 39 (11) ◽  
pp. 1360-1366 ◽  
Author(s):  
Joan Guzik ◽  
Gopi Patel ◽  
Pooja Kothari ◽  
Misha Sharp ◽  
Belinda Ostrowsky ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Collaborative Learning ◽  
York City ◽  
Antibiotic Stewardship ◽  
Respiratory Infections ◽  
Antibiotic Prescribing ◽  
Acute Respiratory Infections ◽  
Prescribing Practices ◽  
The Status

AbstractObjectiveTo assess the status of antibiotic prescribing in the ambulatory setting for adult patients with acute respiratory infections (ARIs) and to identify opportunities and barriers for outpatient antibiotic stewardship programs (ASPs).DesignMixed methods including point prevalence using chart reviews, surveys, and collaborative learning.SettingHospital-owned clinics in the New York City area.Participants/PatientsIn total, 31 hospital-owned clinics from 9 hospitals and health systems participated in the study to assess ARI prescribing practices for patients >18 years old.InterventionsEach clinic performed a survey of current stewardship practices, retrospective chart reviews of prescribing in 30 randomly selected ARI patients from October 2015 to March 2016, and surveys of provider characteristics and knowledge. Clinics participated in collaborative learning with peers and experts in antibiotic stewardship and collected data from June 2016 to August 2016. Sites received data reports by individual clinic, aggregated by hospital, and were compared among participating clinics.ResultsFew sites had outpatient stewardship activities. The retrospective review of 1,004 ARI patients revealed that 37.3% of ARI patients received antibiotics, with significant variation in prescribing practices among sites (17.4%–71.0%; P<.001). Macrolides were the most commonly prescribed antibiotics. Most of the 302 respondents recognized the need for tools to assist in prescribing.ConclusionsThis collaborative study establishes a baseline assessment of the status of outpatient ASPs in New York City. It provides hospitals, health systems, and individual clinics with specific data to inform their development of stewardship interventions targeting ARIs.

scholarly journals Risk factors of acute respiratory infections among under five children attending public hospitals in southern Tigray, Ethiopia, 2016/2017

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Sielu Alemayehu ◽  
Kalayou Kidanu ◽  
Tensay Kahsay ◽  
Mekuria Kassa
Keyword(s):  
Risk Factors ◽  
Respiratory Infection ◽  
Acute Respiratory Infection ◽  
Respiratory Infections ◽  
Public Hospitals ◽  
Cow Dung ◽  
Acute Respiratory Infections ◽  
Under Five ◽  
Under Five Children ◽  
Maternal Literacy

Abstract Background Acute Respiratory infection accounts for 94,037000 disability adjusted life years and 1.9 million deaths worldwide. Acute respiratory infections is the most common causes of under-five illness and mortality. The under five children gets three to six episodes of acute respiratory infections annually regardless of where they live. Disease burden due to acute respiratory infection is 10–50 times higher in developing countries when compared to developed countries. The aim of this study was to assess risk factors of acute respiratory infection among under-five children attending Public hospitals in Southern Tigray, Ethiopia 2016/2017. Methods Institution based case control study was conducted from Nov 2016 to June 2017. Interviewer administered structured questionnaire was used to collect data from a sample of 288 (96 cases and 192 controls) children under 5 years of age. Systematic random sampling was used to recruit study subjects and SPSS version 20 was used to analyze the data. Bivariate and multivariate analysis were employed to examine statistical association between the outcome variable and selected independent variables at 95% confidence level. Level of statistical Significance was declared at p < 0.05. Tables, figures and texts were used to present data. Result One hundred sixty (55.6%) and 128 (44.4%) of the participants were males and females respectively. Malnutrition (AOR = 2.89; 95%CI: 1.584–8.951; p = 0.039), cow dung use (AOR =2.21; 95%CI: 1.121–9.373; p = 0.014), presence of smoker in the family (AOR = 0.638; 95% CI: 0.046–0.980; p = 0.042) and maternal literacy (AOR = 3.098; 95%CI: 1.387–18.729; p = 0.021) were found to be significant predictors of acute respiratory infection among under five children. Conclusion According to this study maternal literacy, smoking, cow dung use and nutritional status were strongly associated with increased risk of childhood acute respiratory infection. Health care providers should work jointly with the general public, so that scientific knowledge and guidelines for adopting particular preventive measures for acute respiratory infection are disseminated.

scholarly journals Place of food cooking is associated with acute respiratory infection among under-five children in Ethiopia: multilevel analysis of 2005–2016 Ethiopian Demographic Health Survey data

2020 ◽  
Vol 48 (1) ◽  
Author(s):  
Abraham Geremew ◽  
Selamawit Gebremedhin ◽  
Yohannes Mulugeta ◽  
Tesfaye Assebe Yadeta
Keyword(s):  
Survey Data ◽  
Respiratory Infection ◽  
Acute Respiratory Infection ◽  
Respiratory Infections ◽  
Acute Respiratory Infections ◽  
Under Five ◽  
Under Five Children ◽  
Health Survey Data ◽  
Solid Biomass Fuel ◽  
Solid Biomass

Abstract Background Globally, acute respiratory infections are among the leading causes of under-five child mortality, especially in lower-income countries; it is associated with indoor exposure to toxic pollutants from solid biomass fuel. In Ethiopia, 90% of the population utilizes solid biomass fuel; respiratory illness is a leading health problem. However, there is a paucity of nationally representative data on the association of household cooking place and respiratory infections. Besides, evidence on the variability in the infection based on the data collected at different times is limited. Therefore, this study is intended to assess the association of food cooking place with acute respiratory infections and the variability in households and surveys. Methods The current analysis is based on the Ethiopian Demographic and Health Survey data collected in 2005, 2011, and 2016 and obtained via online registration. The association of food cooking place with acute respiratory infection was assessed using multilevel modeling after categorizing all factors into child level and survey level, controlling them in a full model. The analyses accounted for a complex survey design using a Stata command “svy.” Result A total of 30,895 under-five children were included in this study, of which 3677 (11.9%) children had an acute respiratory infection, with 12.7% in 2005, 11.9% in 2011, and 11.1% in 2016. The risk of having an infection in under-five children in households that cooked food outdoors was 44% lower (AOR = 0.56, 95% CI = 0.40, 0.75) compared to those households that cooked the food inside the house. There was a statistically significant difference among the children among surveys to have an acute respiratory infection. Conclusion The risk of having children with acute respiratory infection is lower in the households of cooking food outdoor compared to indoor. The infection difference in different surveys suggests progress in the practices in either food cooking places or the fuel types used that minimize food cooking places location or the fuel types used that minimizes the risk. But, the infection is still high; therefore, measures promoting indoor cooking in a well-ventilated environment with alternative energy sources should take place.

scholarly journals Outpatient Antibiotic Prescribing Among United States Nurse Practitioners and Physician Assistants

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
Guillermo V. Sanchez ◽  
Adam L. Hersh ◽  
Daniel J. Shapiro ◽  
James F. Cawley ◽  
Lauri A. Hicks
Keyword(s):  
United States ◽  
Respiratory Infection ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Antibiotic Stewardship ◽  
Acute Respiratory Infection ◽  
Physician Assistant ◽  
Physician Assistants ◽  
Antibiotic Prescribing

Abstract We examined US nurse practitioner (NP) and physician assistant (PA) outpatient antibiotic prescribing. Antibiotics were more frequently prescribed during visits involving NP/PA visits compared with physician-only visits, including overall visits (17% vs 12%, P &lt; .0001) and acute respiratory infection visits (61% vs 54%, P &lt; .001). Antibiotic stewardship interventions should target NPs and PAs.

scholarly journals Association of Acute Respiratory Infections with Indoor Air Pollution from Biomass Fuel Exposure among Under-Five Children in Jimma Town, Southwestern Ethiopia

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Abebaw Addisu ◽  
Tesfalem Getahun ◽  
Mulunesh Deti ◽  
Yilkal Negesse ◽  
Besufekad Mekonnen
Keyword(s):  
Particulate Matter ◽  
Respiratory Infection ◽  
Acute Respiratory Infection ◽  
Indoor Air Pollution ◽  
Respiratory Infections ◽  
Biomass Fuel ◽  
Acute Respiratory Infections ◽  
Under Five ◽  
Under Five Children ◽  
Increased Risk

Background. Most of the households in developing countries burn biomass fuel in traditional stoves with incomplete combustion that leads to high indoor air pollution and acute respiratory infections. Acute respiratory infection is the most common cause of under-five morbidity and mortality accounting for 2 million deaths worldwide and responsible for 18% of deaths among under-five children in Ethiopia. Although studies were done on acute respiratory infections, the majority of studies neither clinically diagnose respiratory infections nor use instant measurement of particulate matter. Methods. The community-based cross-sectional study design was employed among under-five children in Jimma town from May 21 to June 7, 2020. A total of 265 children through systematic random sampling were included in the study. The data were collected using a pretested semistructured questionnaire and laser pm 2.5 meter for indoor particulate matter concentration. Associations among factors were assessed through correlation analysis, and binary logistic regression was done to predict childhood acute respiratory infections. Variables with p -value less than 0.25 in bivariate regression were the candidate for the final multivariate logistic regression. Two independent sample t-tests were done to compare significant mean difference between concentrations of particulate matter. Results. Among 265 under-five children who were involved in the study, 179 (67.5%) were living in households that predominantly use biomass fuel. Prevalence of acute respiratory infections in the study area was 16%. Children living in households that use biomass fuel were four times more likely to develop acute respiratory infections than their counterparts (AOR: 4.348; 95% CI: 1.632, 11.580). The size of household was significantly associated with the prevalence of acute respiratory infections. Under-five children living in households that have a family size of six and greater had odds of 1.7 increased risk of developing acute respiratory infections than their counterparts (AOR: 1.7; 95% CI: 1.299, 2.212). The other factor associated with acute respiratory infection was separate kitchen; children living in households in which there were no separate kitchen were four times at increased risk of developing acute respiratory infection than children living in households which have separate kitchen (AOR: 4.591; 95% CI: 1.849, 11.402). The concentration of indoor particulate matter was higher in households using biomass fuel than clean fuel. There was statistically higher particulate matter concentration in the kitchen than living rooms (t = 4.509, p ≤ 0.001 ). Particulate matter 2.5 concentrations (μg/m3) of the households that had parental smoking were significantly higher than their counterparts (AOR: 20.224; 95% CI: 1.72, 12.58). Conclusion. There is an association between acute respiratory infections and biomass fuel usage among under-five children. Focusing on improved energy sources is essential to reduce the burden and assure the safety of children.

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