scholarly journals Implementation of a Cellulitis Management Plan in Three Australian Regional Health Services to Address an Evidence–Practice Gap in Antibiotic Prescribing

Antibiotics ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1288
Author(s):  
Jaclyn Bishop ◽  
Mark Jones ◽  
James Farquharson ◽  
Kathrine Summerhayes ◽  
Roxanne Tucker ◽  
...  
Keyword(s):  
Health Services ◽  
Management Plan ◽  
Primary Outcome Measure ◽  
Antibiotic Prescribing ◽  
Intention To Treat ◽  
Icd 10 ◽  
Practice Gaps ◽  
Practice Gap ◽  
Evidence Based Guidelines ◽  
Regional Australia

Despite the availability of evidence-based guidelines, antibiotics for cellulitis remain inappropriately prescribed. This evidence–practice gap is more evident in low-resource settings, such as rural hospitals. This implementation study developed and introduced a cellulitis management plan to improve antibiotic prescribing for cellulitis in three health services in regional Australia. Appropriateness of antibiotic prescribing for cellulitis at Day 1 was the primary outcome measure. Adults with ICD-10-AM codes for lower-limb cellulitis admitted as inpatients of the three health services between May and November 2019 (baseline, n = 165) and March and October 2020 (post-implementation, n = 127) were included in the assessment. The uptake of the cellulitis management plan was 29.1% (37/127). The appropriateness of antibiotic prescribing for cellulitis at Day 1 was similar at baseline (78.7%, 144/183) and in the intention-to-treat post-implementation group (81.8%, 126/154) [95% CI −5.6% to 11.3%, p = 0.50]. Commencement of the cellulitis management plan resulted in a non-statistically significant increase in antibiotic appropriateness at Day 1 compared to when a cellulitis management plan was not commenced (88.1% vs. 79.5%; 95% CI −5.6% to 19.8%; p = 0.20) Evaluation of more real-world strategies to address evidence–practice gaps, such as the appropriateness of antibiotic prescribing for cellulitis, is required.

scholarly journals A Descriptive Analysis of Outpatient Antimicrobial Use for Urinary Tract Infections in Virginia

2020 ◽  
Vol 41 (S1) ◽  
pp. s453-s454
Author(s):  
Hasti Mazdeyasna ◽  
Shaina Bernard ◽  
Le Kang ◽  
Emily Godbout ◽  
Kimberly Lee ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Private Insurance ◽  
Geographic Region ◽  
Study Cohort ◽  
Antibiotic Prescribing ◽  
Prescribing Trends ◽  
Icd 10 ◽  
Tract Infections ◽  
Insurance Payer

Background: Data regarding outpatient antibiotic prescribing for urinary tract infections (UTIs) are limited, and they have never been formally summarized in Virginia. Objective: We describe outpatient antibiotic prescribing trends for UTIs based on gender, age, geographic region, insurance payer and International Classification of Disease, Tenth Revision (ICD-10) codes in Virginia. Methods: We used the Virginia All-Payer Claims Database (APCD), administered by Virginia Health Information (VHI), which holds data for Medicare, Medicaid, and private insurance. The study cohort included Virginia residents who had a primary diagnosis of UTI, had an antibiotic claim 0–3 days after the date of the diagnosis and who were seen in an outpatient facility in Virginia between January 1, 2016, and December 31, 2016. A diagnosis of UTI was categorized as cystitis, urethritis or pyelonephritis and was defined using the following ICD-10 codes: N30.0, N30.00, N30.01, N30.9, N30.90, N30.91, N39.0, N34.1, N34.2, and N10. The following antibiotics were prescribed: aminoglycosides, sulfamethoxazole/trimethoprim (TMP-SMX), cephalosporins, fluoroquinolones, macrolides, penicillins, tetracyclines, or nitrofurantoin. Patients were categorized based on gender, age, location, insurance payer and UTI type. We used χ2 and Cochran-Mantel-Haenszel testing. Analyses were performed in SAS version 9.4 software (SAS Institute, Cary, NC). Results: In total, 15,580 patients were included in this study. Prescriptions for antibiotics by drug class differed significantly by gender (P < .0001), age (P < .0001), geographic region (P < .0001), insurance payer (P < .0001), and UTI type (P < .0001). Cephalosporins were prescribed more often to women (32.48%, 4,173 of 12,846) than to men (26.26%, 718 of 2,734), and fluoroquinolones were prescribed more often to men (53.88%, 1,473 of 2,734) than to women (47.91%, 6,155 of 12,846). Although cephalosporins were prescribed most frequently (42.58%, 557 of 1,308) in northern Virginia, fluoroquinolones were prescribed the most in eastern Virginia (50.76%, 1677 of 3,304). Patients with commercial health insurance, Medicaid, and Medicare were prescribed fluoroquinolones (39.31%, 1,149 of 2,923), cephalosporins (56.33%, 1,326 of 2,354), and fluoroquinolones (57.36%, 5,910 of 10,303) most frequently, respectively. Conclusions: Antibiotic prescribing trends for UTIs varied by gender, age, geographic region, payer status and UTI type in the state of Virginia. These data will inform future statewide antimicrobial stewardship efforts.Funding: NoneDisclosures: Michelle Doll reports a research grant from Molnlycke Healthcare.

Antibiotic Prescribing in Adults Presenting with Pharyngitis Pre- and Post-Implementation of a Rapid Group A Streptococcus Test

2021 ◽  
pp. 001857872110323
Author(s):  
Preeyaporn Sarangarm ◽  
Timothy A. Huerena ◽  
Tatsuya Norii ◽  
Carla J. Walraven
Keyword(s):  
Group A Streptococcus ◽  
Intervention Group ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Care Clinic ◽  
Rapid Antigen Detection Test ◽  
Appropriate Prescribing ◽  
Icd 10 ◽  
Group A

Background: Group A Streptococcus (GAS) pharyngitis is the most common bacterial cause of acute pharyngitis and is often over treated with unnecessary antibiotics. The purpose was to evaluate if implementation of a rapid antigen detection test (RADT) for GAS would reduce the number of inappropriately prescribed antibiotics for adult patients presenting with symptoms of pharyngitis. Methods: This was a retrospective cohort study of adult urgent care clinic patients pre- and post-implementation of a GAS RADT. We included patients who had a diagnosis of GAS identified via ICD-10 codes and either a throat culture, GAS RADT, or antibiotic prescribed for GAS. Antibiotic prescribing was assessed as appropriate or inappropriate based on testing and IDSA guideline recommendations. Thirty-day follow-up visits related to pharyngitis or the prescribed antibiotics was also evaluated. Results: A total of 1734 patients were included; 912 and 822 in the pre- and post-implementation groups, respectively. Following implementation of the GAS RADT, there was an increase in the number of antibiotics prescribed for GAS (43.4% vs 59.1%, P < .001) as well as an increase in appropriate prescribing (67.6% vs 77.5%, P < .001). More 30-day pharyngitis-related follow-up visits were seen in the pre-intervention group (12.5% vs 9.3%, P = .03). Conclusion: Implementation of a RADT for GAS pharyngitis was associated with an increase in both the overall number of antibiotic prescriptions for GAS and the proportion of appropriately prescribed antibiotics. There was also a reduction in follow up visits related to GAS pharyngitis, however educational efforts to further increase appropriate prescribing is needed.

scholarly journals Development of an Electronic Algorithm to Target Outpatient Antimicrobial Stewardship Efforts for Acute Bronchitis

2020 ◽  
Vol 41 (S1) ◽  
pp. s32-s32
Author(s):  
Ebbing Lautenbach ◽  
Keith Hamilton ◽  
Robert Grundmeier ◽  
Melinda Neuhauser ◽  
Lauri Hicks ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Predictive Value ◽  
Gold Standard ◽  
Chart Review ◽  
Acute Bronchitis ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Diagnostic Codes ◽  
Icd 10 ◽  
The Impact

Background: Antibiotic resistance has increased at alarming rates, driven predominantly by antibiotic overuse. Although most antibiotic use occurs in outpatients, antimicrobial stewardship programs have primarily focused on inpatient settings. A major challenge for outpatient stewardship is the lack of accurate and accessible electronic data to target interventions. We sought to develop and validate an electronic algorithm to identify inappropriate antibiotic use for outpatients with acute bronchitis. Methods: This study was conducted within the University of Pennsylvania Health System (UPHS). We used ICD-10 diagnostic codes to identify encounters for acute bronchitis at any outpatient UPHS practice between March 15, 2017, and March 14, 2018. Exclusion criteria included underlying immunocompromising condition, other comorbidity influencing the need for antibiotics (eg, emphysema), or ICD-10 code at the same visit for a concurrent infection (eg, sinusitis). We randomly selected 300 (150 from academic practices and 150 from nonacademic practices) eligible subjects for detailed chart abstraction that assessed patient demographics and practice and prescriber characteristics. Appropriateness of antibiotic use based on chart review served as the gold standard for assessment of the electronic algorithm. Because antibiotic use is not indicated for this study population, appropriateness was assessed based upon whether an antibiotic was prescribed or not. Results: Of 300 subjects, median age was 61 years (interquartile range, 50–68), 62% were women, 74% were seen in internal medicine (vs family medicine) practices, and 75% were seen by a physician (vs an advanced practice provider). On chart review, 167 (56%) subjects received an antibiotic. Of these subjects, 1 had documented concern for pertussis and 4 had excluding conditions for which there were no ICD-10 codes. One received an antibiotic prescription for a planned dental procedure. Thus, based on chart review, 161 (54%) subjects received antibiotics inappropriately. Using the electronic algorithm based on diagnostic codes, underlying and concurrent conditions, and prescribing data, the number of subjects with inappropriate prescribing was 170 (56%) because 3 subjects had antibiotic prescribing not noted based on chart review. The test characteristics of the electronic algorithm (compared to gold standard chart review) for identification of inappropriate antibiotic prescribing were the following: sensitivity, 100% (161 of 161); specificity, 94% (130 of 139); positive predictive value, 95% (161 of 170); and negative predictive value, 100% (130 of 130). Conclusions: For outpatients with acute bronchitis, an electronic algorithm for identification of inappropriate antibiotic prescribing is highly accurate. This algorithm could be used to efficiently assess prescribing among practices and individual clinicians. The impact of interventions based on this algorithm should be tested in future studies.Funding: NoneDisclosures: None

scholarly journals 967. Concordance of Antibiotic Prescribing with the Proposed American Dental Association Acute Oral Infection Guidelines within Veterans Affairs (VA) Dentistry

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S31-S32
Author(s):  
Daniel Carlsen ◽  
Katie J Suda ◽  
Ursula C Patel ◽  
Gretchen Gibson ◽  
Marianne M Jurasic ◽  
...  
Keyword(s):  
Dental Treatment ◽  
Apical Periodontitis ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
Oral Infections ◽  
American Dental Association ◽  
Dental Procedures ◽  
Icd 10 ◽  
Future Work ◽  
Irreversible Pulpitis

Abstract Background US dentists prescribe 10% of outpatient antibiotics. However, assessing the appropriateness of dental antibiotic prescribing has been challenging due to a lack of guidelines for common infections. In 2019, the American Dental Association proposed clinical practice guidelines (CPG) on the management of common acute oral infections for the first time. Our objective was to describe national baseline antibiotic prescribing for the treatment of irreversible pulpitis, apical periodontitis, and acute apical abscess prior to the release of the proposed CPG. Methods We performed a cross-sectional analysis of national VA data from January 1, 2017 to December 31, 2017. We identified cases of irreversible pulpitis, apical periodontitis, and acute apical abscess using ICD-10-CM codes. Patient demographics, facility location, medical conditions, dental procedure codes (“CDTs”), and diagnostic (ICD-10-CM) codes were extracted from the VA Corporate Data Warehouse. Antibiotics prescribed by a dentist within 7 days of a visit were included. Multivariable logistic regression identified variables associated with antibiotic prescribing for each infection. Results Of the 470,039 VA dental visits with oral infections coded, 25% of irreversible pulpitis, 41% of apical periodontitis, and 61% of acute apical abscess visits received antibiotics. Amoxicillin was prescribed most frequently. Although the median days’ supply was 7 days, prolonged use of antibiotics was frequent (9.2% of irreversible pulpitis, 17.8% of apical periodontitis, 28.7% of acute apical abscess received antibiotics for ≥8 days). Of the irreversible pulpitis visits with antibiotics prescribed, 20.0% received ≥2 antibiotics. Patients with high-risk cardiac conditions, prosthetic joints, and certain dental procedures were associated with receipt of antibiotics (table). Conclusion Prior to the release of the ADA guidelines, 75.8% and 59.4% of irreversible pulpitis and apical periodontitis were concordant with proposed recommendations. These data identify opportunities to improve prescribing and serve as a benchmark for future outpatient antimicrobial stewardship efforts. Future work should assess definitive dental treatment and populations without access to oral health care. Disclosures All Authors: No reported Disclosures.

Cases of Dispute and Pending Claims in Hospitals in the Era of National Health Insurance

2022 ◽  
Vol 2 (1) ◽  
pp. 32-38
Author(s):  
Mrs. Yastori
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
National Health Insurance ◽  
National Health ◽  
National Health Insurance System ◽  
Quality Health ◽  
Icd 10 ◽  
Data Collection Technique ◽  
Observation Method

Background: Indonesia began to implement a National Health Insurance System based on the National Social Security System in 2014 with the support of government regulations which states that Indonesia requires every citizen to have access to comprehensive and quality health services so that can continue their life through the National Health Insurance. Pending and dispute claims are problems that often occur in the era of national health insurance that can affect hospital budget allocation and planning policies, increasing the high cost burden for hospitals which will affect the quality of health services provided. The purpose of this study was to determine pending cases and dispute claims in hospitals in the Era of National Health Insurance.Methods: The study used a descriptive method with a qualitative approach. The data collection technique used is the observation method, namely directly to the e-claim file at several hospitals. 15 e-claim files taken in total from April – July 2021.Results: Obtained 13 cases of pending claims and 2 cases of dispute claims. Cases pending claims are caused by not complying with the code with evidence or resources, not in accordance with medical clinical practice guidelines and the rules of the health insurance provider.Conclusions: In coding, it is necessary to match the theory on the ICD-10, update the ICD-10. It is necessary to understand the rules and provisions made by the insurer and the related guidelines and rules. Please be aware of every latest code update.

Analysis of health administration data to inform health service planning for paediatric palliative care

2020 ◽  
pp. bmjspcare-2020-002449
Author(s):  
Alison Pauline Bowers ◽  
Natalie Bradford ◽  
Raymond Javan Chan ◽  
Anthony Herbert ◽  
Patsy Yates
Keyword(s):  
Palliative Care ◽  
Health Service ◽  
Health Services ◽  
Hospital Admissions ◽  
Demographic Characteristics ◽  
Service Planning ◽  
Service Usage ◽  
Paediatric Palliative Care ◽  
Icd 10 ◽  
Limiting Condition

BackgroundHealth service planning in paediatric palliative care is complex, with the diverse geographical and demographic characteristics adding to the challenge of developing services across different nations. Accurate and reliable data are essential to inform effective, efficient and equitable health services.AimTo quantify health service usage by children and young people aged 0–21 years with a life-limiting condition admitted to hospital and health service facilities in Queensland, Australia during the 2011 and 2016 calendar years, and describe the clinical and demographic characteristics associated with health services usage.DesignRetrospective health administrative data linkage of clinical and demographic information with hospital admissions was extracted using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision Australian Modification (ICD-10-AM) diagnostic codes. Data were analysed using descriptive statistics.Setting/participantsIndividuals aged 0–21 years with a life-limiting condition admitted to a Queensland Public Hospital and Health Service or private hospital.ResultsHospital admissions increased from 17 955 in 2011 to 23 273 in 2016, an increase of 5318 (29.6%). The greatest percentage increase in admissions were for those aged 16–18 years (58.1%, n=1050), and those with non-oncological conditions (36.2%, n=4256). The greatest number of admissions by ICD-10-AM chapter for 2011 and 2016 were by individuals with neoplasms (6174, 34.4% and 7206, 31.0% respectively). Overall, the number of admissions by Indigenous children and young people increased by 70.2% (n=838).ConclusionsAdministrative data are useful to describe clinical and demographic characteristics and quantify health service usage. Available data suggest a growing demand for health services by children eligible for palliative care that will require an appropriate response from health service planners.

scholarly journals 1123. Specificity of Diagnosis Codes and Adequacy of Supportive Documentation for Common Acute Pediatric Infections: Implications for Ambulatory Stewardship

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S399-S399
Author(s):  
Zachary Willis ◽  
Elizabeth Walters
Keyword(s):  
Acute Otitis Media ◽  
Antibiotic Prescribing ◽  
National Guidelines ◽  
Laboratory Findings ◽  
Healthcare Settings ◽  
Diagnosis Codes ◽  
Icd 10 ◽  
Pediatric Infections ◽  
Data Elements ◽  
Physical Findings

Abstract Background Assessing the appropriateness of antibiotic prescribing in ambulatory care generally relies on the accuracy of diagnosis codes, which is uncertain. It is also uncertain if documented history and physical findings support antibiotic indications (AI). We completed a retrospective study of pediatric primary care (PPC) encounters to determine: A) if documented findings supported documented AI; and B) whether diagnosis codes captured documented AI (figure). Methods We conducted point-prevalence audits of the 9 PPC clinics in our healthcare system, randomly selecting one weekday per month to review all visits between 9/2017 and 4/2018. We included only encounters with antibiotic prescribing. We reviewed clinician notes, orders, laboratory results, and ICD-10 diagnosis codes. We recorded demographics; visit date/location; AI as documented in notes; history, examination, and laboratory findings; and diagnosis codes. We used national guidelines to determine whether documentation supported AI. We calculated the sensitivity of diagnosis codes using documented AI as the gold standard. Results The sample included 452 encounters. The most common AI were acute otitis media (AOM), pharyngitis, and sinusitis. For AOM, 163 of 168 encounters (97.0%) had an appropriate diagnosis code; for pharyngitis, 127 of 138 (92.0%); and for sinusitis, 68 of 75 (90.7%). For AOM, 160 of 168 encounters (95.2%) had adequate documentation of supportive findings. For sinusitis, 44 of 75 encounters had adequate supporting history and/or examination findings (58.7%). For pharyngitis, while 135 of 139 (97.1%) had a positive streptococcal test, 104 of 139 (74.8%) had history and examination findings to support testing. Conclusion By chart review, we identified each AI and evaluated whether findings supported those AI. The sensitivity of diagnosis codes for AI ranged from 90.7–97.0% for common conditions; this result can inform the design of ambulatory stewardship programs. Only 74.8% of children treated for pharyngitis and 58.7% of children treated for sinusitis had sufficient supporting documentation. Use of discrete data elements alone (Figure 1) may result in overestimates of the proportion of children for whom antibiotics are appropriate. Further research is needed across healthcare settings. Disclosures All authors: No reported disclosures

scholarly journals The Penicillin Allergy Delabeling Program: A Multicenter Whole-of-Hospital Health Services Intervention and Comparative Effectiveness Study

2020 ◽  
Author(s):  
Kyra Y L Chua ◽  
Sara Vogrin ◽  
Susan Bury ◽  
Abby Douglas ◽  
Natasha E Holmes ◽  
...  
Keyword(s):  
Health Services ◽  
Propensity Score Analysis ◽  
Antibiotic Use ◽  
Low Risk ◽  
Penicillin Allergy ◽  
Index Admission ◽  
Relative Risk Ratio ◽  
Antibiotic Prescribing ◽  
Narrow Spectrum ◽  
Oral Penicillin

Abstract Background Penicillin allergies are associated with inferior patient and antimicrobial stewardship outcomes. We implemented a whole-of-hospital program to assess the efficacy of inpatient delabeling for low-risk penicillin allergies in hospitalized inpatients. Methods Patients ≥ 18 years of age with a low-risk penicillin allergy were offered a single-dose oral penicillin challenge or direct label removal based on history (direct delabeling). The primary endpoint was the proportion of patients delabeled. Key secondary endpoints were antibiotic utilization pre- (index admission) and post-delabeling (index admission and 90 days). Results Between 21 January 2019 and 31 August 2019, we assessed 1791 patients reporting 2315 antibiotic allergies, 1225 with a penicillin allergy. Three hundred fifty-five patients were delabeled: 161 by direct delabeling and 194 via oral penicillin challenge. Ninety-seven percent (194/200) of patients were negative upon oral penicillin challenge. In the delabeled patients, we observed an increase in narrow-spectrum penicillin usage (adjusted odds ratio [OR], 10.51 [95% confidence interval {CI}, 5.39–20.48]), improved appropriate antibiotic prescribing (adjusted OR, 2.13 [95% CI, 1.45–3.13]), and a reduction in restricted antibiotic usage (adjusted OR, 0.38 [95% CI, .27–.54]). In the propensity score analysis, there was an increase in narrow-spectrum penicillins (OR, 10.89 [95% CI, 5.09–23.31]) and β-lactam/β-lactamase inhibitors (OR, 6.68 [95% CI, 3.94–11.35]) and a reduction in restricted antibiotic use (OR, 0.52 [95% CI, .36–.74]) and inappropriate prescriptions (relative risk ratio, 0.43 [95% CI, .26–.72]) in the delabeled group compared with the group who retained their allergy label. Conclusions This health services program using a combination of direct delabeling and oral penicillin challenge resulted in significant impacts on the use of preferred antibiotics and appropriate prescribing.

Mobile phone technology in the management of asthma

2005 ◽  
Vol 11 (1_suppl) ◽  
pp. 43-46 ◽  
Author(s):  
D Ryan ◽  
W Cobern ◽  
J Wheeler ◽  
D Price ◽  
L Tarassenko
Keyword(s):  
Mobile Phone ◽  
Peak Flow ◽  
Management Plan ◽  
Primary Outcome Measure ◽  
Ease Of Use ◽  
Telemedicine System ◽  
Mobile Phone Technology ◽  
Inhaled Steroids ◽  
Flow Monitoring ◽  
Practice Population

Peak flow monitoring is widely recommended as part of a self-management plan for asthma. We conducted an observational study using electronic peak flow monitoring and mobile phone technology in a UK general practice population over a nine-month period. Patients between 12 and 55 years of age who required treatment with regular inhaled steroids and (as needed) bronchodilators were recruited from nine general practices. Patients were included if their asthma was considered stable (i.e. no exacerbation in the previous three months). No therapeutic intervention was proposed. The primary outcome measure was compliance. In all, 69% of the 46 participants who filled in the post-study questionnaire were ‘satisfied’ or ‘very satisfied’ by the study, citing the ease of use and the increased autonomy and understanding of asthma as the main advantages. In total, 74% indicated that the system had helped to improve their ability to manage their symptoms. The most positive features of the telemedicine system were described as follows: increased awareness and information about asthma, improved ability to monitor/manage the condition with the feedback screens on the mobile phone and ease of use.

Delivering Health Services for Ethnic Minorities in Regional Australia

1998 ◽  
Vol 4 (1) ◽  
pp. 72 ◽  
Author(s):  
Lorna Moxham ◽  
Shane Pegg
Keyword(s):  
Health Care ◽  
Health Services ◽  
Ethnic Minorities ◽  
Culturally Diverse ◽  
Client Group ◽  
Professional Health ◽  
Culture And Health ◽  
Care Worker ◽  
Regional Australia ◽  
Diverse Nations

Recent articles in the print media have served to highlight the fact that health services in regional Australia are inadequately servicing the needs of ethnic minorities. Despite an increased awareness of the need for culturally appropriate services in more recent years, Australia, as one of the most ethno-culturally diverse nations in the world, still largely relies on the patriarchal biomedical model of health care, which has a pathogenic approach, focusing on why people fall sick and on treatment, rather than on communication between the client and the professional health care worker. Such practice, while well-intentioned, detracts from the ability of regional health services to adequately service the needs of a culturally diverse client group and, in turn, de-emphasises the clear link which has now been established between culture and health.

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