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A multimodal intervention to decrease inappropriate outpatient antibiotic prescribing for upper respiratory tract infections in a large integrated healthcare system

Published online by Cambridge University Press:  02 May 2022

Lisa E. Davidson Open the ORCID record for Lisa E. Davidson [Opens in a new window] ,
Erin M. Gentry ,
Jennifer S. Priem ,
Marc Kowalkowski  and
Melanie D. Spencer
Lisa E. Davidson*
Affiliation:
Division of Infectious Disease, Department of Internal Medicine, Atrium Health, Charlotte, North Carolina
Erin M. Gentry
Affiliation:
Antimicrobial Support Network, Division of Pharmacy, Atrium Health, Charlotte, North Carolina
Jennifer S. Priem
Affiliation:
Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina
Marc Kowalkowski
Affiliation:
Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina
Melanie D. Spencer
Affiliation:
Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina
*
Author for correspondence: Lisa E. Davidson, MD, FIDSA, E-mail: Lisa.Davidson@AtriumHealth.org
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Abstract

Objective:

To evaluate the effectiveness of Carolinas Healthcare Outpatient Antimicrobial Stewardship Empowerment Network (CHOSEN), a multicomponent outpatient stewardship program to reduce inappropriate antibiotic prescribing for upper respiratory infections by 20% over 2 years.

Design:

Before-and-after interrupted time series of antibiotics prescribed between 2 periods: April 2016–October 2017 and May 2018–March 2020.

Setting:

The study included 162 primary-care practices within a large healthcare system in the greater Charlotte, North Carolina region.

Participants:

Adult and pediatric patients with encounters for upper respiratory infections for which an antibiotic is inappropriate.

Methods:

Patient and provider educational materials, along with a web-based provider prescribing dashboard aimed at reducing inappropriate antibiotic prescribing were developed and distributed. Monthly antibiotic prescribing rates were calculated as the number of eligible encounters with an antibiotic prescribed divided by the total number of eligible encounters. A segmented regression analysis compared monthly antibiotic prescribing rates before versus after CHOSEN implementation, while also accounting for practice type and seasonal trends in prescribing.

Results:

Overall, 286,580 antibiotics were prescribed during 704,248 preintervention encounters and 277,177 during 832,200 intervention encounters. Significant reductions in inappropriate prescribing rates were observed in all outpatient specialties: family medicine (relative difference before and after the intervention, −20.4%), internal medicine (−19.5%), pediatric medicine (−17.2%), and urgent care (−16.6%).

Conclusions:

A robust multimodal intervention that combined a provider prescribing dashboard with a targeted education campaign demonstrated significant decreases in inappropriate outpatient antibiotic prescribing for upper respiratory tract infections in a large integrated ambulatory network.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 3 , March 2023 , pp. 392 - 399
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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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Footnotes

PREVIOUS PRESENTATION: The study design and preliminary data were presented in 2 posters (nos. 1839 and 1840) at IDWeek 2018 on October 6, 2018, in San Francisco, California, and as an oral abstract (no. 1879) at IDWeek 2019 on October 4, 2019, in Washington, DC.

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