A multimodal intervention to decrease inappropriate outpatient antibiotic prescribing for upper respiratory tract...

Area of Science:

• Infectious Diseases
• Public Health
• Health Services Research

Background:

• Antibiotic resistance is a growing global health threat.
• Inappropriate antibiotic prescribing for upper respiratory infections contributes to resistance.
• Outpatient settings are a key target for antimicrobial stewardship interventions.

Purpose of the Study:

• To evaluate the effectiveness of the Carolinas Healthcare Outpatient Antimicrobial Stewardship Empowerment Network (CHOSEN) program.
• To reduce inappropriate antibiotic prescribing for upper respiratory infections by 20% over two years.
• To assess the impact of a multicomponent stewardship program in a large healthcare system.

Main Methods:

• A before-and-after interrupted time series study design was employed.
• The intervention included patient and provider education and a web-based prescribing dashboard.
• Segmented regression analysis was used to compare prescribing rates pre- and post-intervention, controlling for covariates.

Main Results:

• Over 1.5 million encounters were analyzed.
• Inappropriate antibiotic prescribing rates decreased significantly in all outpatient specialties.
• Reductions ranged from -16.6% in urgent care to -20.4% in family medicine.

Conclusions:

• A multimodal intervention combining a prescribing dashboard and education effectively reduced inappropriate outpatient antibiotic prescribing.
• The CHOSEN program demonstrated success in a large integrated ambulatory network.
• These findings support the implementation of similar stewardship programs to combat antibiotic resistance.