A Learning Collaborative to Improve Antibiotic Prescribing in Primary Care Pediatric Practices

Area of Science:

• Pediatric Quality Improvement
• Antibiotic Stewardship
• Infectious Disease Management

Background:

• Inappropriate antibiotic prescribing for pediatric upper respiratory infections (URI) and acute otitis media (AOM) remains a significant public health concern.
• Effective patient education is crucial for managing expectations and promoting appropriate antibiotic use in pediatric primary care.
• Quality improvement collaboratives offer a structured approach to implementing evidence-based practices in independent pediatric settings.

Purpose of the Study:

• To assess the impact of a 6-month online quality improvement learning collaborative on antibiotic prescribing and patient education for URI and AOM in pediatric practices.
• To evaluate the adoption and maintenance of improved practices in independent, private primary care settings.
• To measure changes in the use of first-line antibiotics, safety-net antibiotic prescriptions (SNAP), and patient education for URI and AOM.

Main Methods:

• A 6-month, primarily online quality improvement learning collaborative was implemented, involving 53 clinicians from 6 independent pediatric practices.
• Data on quality measures, including antibiotic prescribing and patient education, were collected at baseline, monthly, and 4 months post-project.
• The collaborative focused on improving antibiotic stewardship for URI and AOM, emphasizing evidence-based guidelines and patient engagement strategies.

Main Results:

• Use of first-line antibiotics for AOM increased significantly from 63.5% to 80.4% at 4 months post-project.
• Patient education for URI management rose from 66.1% to 88.0%, and for AOM from 20.4% to 85.6%.
• High performance in avoiding antibiotics for URI was maintained (94.4% to 96.2%), while SNAP use for AOM increased from 4.5% to 16.9%.

Conclusions:

• The online quality improvement collaborative effectively improved antibiotic prescribing and patient education for URI and AOM in independent pediatric practices.
• The project demonstrated a replicable model for antibiotic stewardship, leveraging local and national resources to engage private practices.
• Sustained improvements in appropriate antibiotic use and patient education highlight the value of collaborative learning in pediatric primary care.