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Published on: August 30, 2018
Improvements in appropriate ambulatory antibiotic prescribing using a bundled antibiotic stewardship intervention in
Sophie E Katz1, Preston Spencer2, Janet Cates2
1Dvision of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee.
Insights
Bundled implementation strategies significantly improved appropriate antibiotic prescribing for children in Tennessee. These improvements were sustained even during the COVID-19 pandemic, showing high provider acceptance.
Area of Science:
- Pediatric infectious disease management
- Antimicrobial stewardship programs
- Healthcare quality improvement
Background:
- Inappropriate antibiotic prescribing in pediatric care contributes to antimicrobial resistance.
- Effective strategies are needed to optimize antibiotic use in community pediatrics.
Purpose of the Study:
- To enhance appropriate antibiotic prescribing for children in Tennessee using bundled implementation strategies.
- To assess the impact of these strategies before and during the COVID-19 pandemic.
Main Methods:
- A before-and-after intervention study was conducted in 5 community general pediatrics practices.
- 81 pediatric providers implemented 2-4 evidence-based strategies, supported by champions and quarterly peer feedback.
- Data were collected across three periods: baseline, pre-pandemic intervention, and during the COVID-19 pandemic.
Main Results:
- Guideline-concordant antibiotic prescribing improved significantly for otitis media, streptococcal pharyngitis, pneumonia, sinusitis, and skin infections.
- Improvements observed pre-pandemic were sustained during the COVID-19 pandemic period.
- For example, otitis media prescribing increased from 72.14% to 86.11%.
Conclusions:
- Bundled implementation strategies effectively increased appropriate antibiotic prescribing for common pediatric diagnoses.
- The positive impact on antibiotic prescribing was maintained throughout the study, including during the COVID-19 pandemic.
- Participating providers found the implementation strategies to be well-accepted.
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.
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