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Improving antibiotic adherence in treatment of acute upper respiratory infections: a quality improvement process
Rittu Hingorani1, Maryam Mahmood2, Richard Alweis2
1Internal Medicine Department, Reading Health System, West Reading PA, USA; ; Rittu.HingoraniMD@readinghealth.org.
Introduction:
Approximately 25 million people in the United States visit their primary care physician each year for acute respiratory infections (ARI). They are a common cause of unnecessary prescription of antibiotics; despite well-validated national treatment guidelines, around 73% of adults with ARI are prescribed antibiotics in the United States. Inappropriate use of antibiotics has profound implications.
Methods:
Our aim was to increase adherence to antibiotic guidelines for treatment of ARI in an internal medicine outpatient practice. We used a package of active and passive interventions to improve physician awareness of treatment guidelines; these included short sessions of didactic teaching, antibiotic guidelines posters in patient examination rooms and staff areas, clinical decision support (CDS) tools integrated into the electronic medical record system, guideline adherence report cards for providers, and reiteration of CDS tool use and guideline adherence at monthly group meetings. Process measures were the rate of use of CDS tools for the management of ARI and patient callbacks within 72 h for the same issue. Outcome measures were compliance with antibiotic prescribing guidelines.
Results:
Our low-cost interventions led to a significant improvement in ARI treatment guideline adherence. There was improvement in compliance with treatment guidelines for sinusitis (90.90% vs. 57.58%, p<0.001), pharyngitis (64.28% vs. 25.00%, p=0.003), upper respiratory infection (96.18% vs. 73.68%, p=0.008), and the aggregated measure of ARI (91.25% vs. 78.6%, p<0.001). Rate of CDS tool usage was 40.5% with a 72-h callback rate of 0.05%.
Conclusion:
Simple, low-cost interventions can improve appropriate antibiotic use for ARI and change the prescribing habits of providers in an outpatient setting. Provider and patient education is a vital component of antibiotic stewardship. Simple interventions for common outpatient conditions can have a positive impact on patient outcomes and reduce unnecessary healthcare costs.
Insights
Simple interventions significantly improved antibiotic guideline adherence for acute respiratory infections (ARI) in outpatient settings. This approach enhances antibiotic stewardship and reduces unnecessary antibiotic prescriptions.
Area of Science:
- Internal Medicine
- Infectious Diseases
- Public Health
Background:
- Acute respiratory infections (ARI) are a common reason for primary care visits, often leading to unnecessary antibiotic prescriptions.
- Despite guidelines, approximately 73% of adults with ARI receive antibiotics, contributing to antibiotic resistance.
- Inappropriate antibiotic use has significant negative implications for public health.
Purpose of the Study:
- To enhance adherence to antibiotic prescribing guidelines for acute respiratory infections (ARI) in an internal medicine outpatient practice.
- To evaluate the effectiveness of a multi-faceted intervention package aimed at improving physician awareness and application of ARI treatment guidelines.
Main Methods:
- Implemented a combination of active and passive interventions: didactic teaching, guideline posters, electronic clinical decision support (CDS) tools, and provider feedback.
- Monitored the utilization rate of CDS tools and patient callback rates within 72 hours.
- Assessed compliance with antibiotic prescribing guidelines as the primary outcome measure.
Main Results:
- Low-cost interventions resulted in significant improvements in guideline adherence for sinusitis, pharyngitis, and overall ARI.
- Compliance increased from 57.58% to 90.90% for sinusitis (p<0.001) and from 73.68% to 96.18% for upper respiratory infections (p=0.008).
- The aggregated ARI guideline adherence improved from 78.6% to 91.25% (p<0.001), with a 40.5% CDS tool usage rate and a low 72-hour callback rate of 0.05%.
Conclusions:
- Simple, cost-effective interventions can effectively improve appropriate antibiotic prescribing for ARI in outpatient settings.
- Provider and patient education are crucial components of successful antibiotic stewardship programs.
- Implementing such interventions can positively impact patient outcomes and reduce healthcare costs associated with unnecessary antibiotic use.
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