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Improvements in appropriate ambulatory antibiotic prescribing using a bundled antibiotic stewardship intervention in general pediatrics practices

Published online by Cambridge University Press:  31 January 2022

Sophie E. Katz Open the ORCID record for Sophie E. Katz [Opens in a new window] ,
Preston Spencer ,
Janet Cates ,
Lora Harnack ,
Meng Xu  and
Ritu Banerjee
Sophie E. Katz*
Affiliation:
Dvision of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
Preston Spencer
Affiliation:
Cumberland Pediatric Foundation, Nashville, Tennessee
Janet Cates
Affiliation:
Cumberland Pediatric Foundation, Nashville, Tennessee
Lora Harnack
Affiliation:
Cumberland Pediatric Foundation, Nashville, Tennessee
Meng Xu
Affiliation:
Vanderbilt University, Department of Biostatistics, Nashville, Tennessee
Ritu Banerjee
Affiliation:
Dvision of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
*
Author for correspondence: Sophie E. Katz, E-mail: sophie.e.katz@vumc.org
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Abstract

Objective:

To improve appropriate antibiotic prescribing for children in Tennessee.

Design:

We performed a before-and-after intervention study with 3 comparison periods: period 1 (P1, baseline) May 2018–September 2019; period 2 (P2, intervention before the COVID-19 pandemic) November 11, 2019–March 20, 2020; and period 3 (P3, intervention during the coronavirus disease 2019 [COVID-19] pandemic) March 21, 2020–November 10, 2020. We additionally surveyed participating providers to assess acceptance of the intervention.

Setting:

Community general pediatrics practices.

Participants:

In total, 81 general pediatricians, family medicine physicians, and nurse practitioners in 5 general pediatrics practices participated in this study.

Interventions:

Each practice identified a practice and operations champion for the project. Practices chose 2–4 implementation strategies previously shown to be effective at reducing outpatient antibiotic use to implement in their practice throughout the study intervention period. Study personnel also held quarterly meetings with all providers to review deidentified peer comparison feedback both across practices enrolled in the study and at the provider level within each practice.

Results:

We detected improvements in guideline-concordant antibiotic use in the pre-COVID-19 intervention period, and they were sustained in the study period during the pandemic (P3): otitis media (P1 72.14% vs P2 81.42% vs P3 86.11%), group A streptococcal pharyngitis (P1 66.13% vs P2 81.56% vs P3 80.44%), pneumonia (P1 70.6% vs P2 76.2% vs P3 100%), sinusitis (P1 76.2% vs P2 83.78% vs P3 82.86%), skin and soft-tissue infections (P1 97.18% vs P2 100% vs P3 100%).

Conclusions:

Bundled implementation strategies led to significant increases in guideline-concordant antibiotic prescribing for all diagnoses. Survey results demonstrate that the bundled implementation strategies were well-accepted by providers.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 12 , December 2022 , pp. 1894 - 1900
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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