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Published on: August 30, 2018
Impact of a pilot multimodal intervention to decrease antibiotic use for respiratory infections in a geriatric clinic
Lakshmi R Chauhan1, Misha Huang1, Mona Abdo2
1Division of Infectious Diseases, Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora, Colorado.
Background:
More than 80% of antibiotics are prescribed in the outpatient setting, of which 30% are inappropriate. The National Action Plan for Combating Antimicrobial Resistance called for a 50% decrease in outpatient antibiotic use by 2020. Inappropriate antibiotics are associated with adverse reactions and Clostridioides difficile infection, especially among older adults.
Study Design:
Before and after study.
Methods:
We performed a quality improvement initiative at the University of Colorado Seniors Clinic. Providers received education on antibiotic guidelines, electronic antibiotic order sets were introduced with standardized stop dates. Antibiotic use data were collected for 6 months before and 6 months after the intervention, from December to May to avoid seasonal variation. Descriptive statistics and linear mixed-effects regression models were used for this comparison.
Results:
Total antibiotic prescriptions for acute respiratory conditions decreased from 137 prescriptions before the intervention (December 1, 2017, to May 31, 2018) to 112 prescriptions after the intervention (December 1, 2018, to May 31, 2019), driven primarily by decreases in antibiotic prescriptions for pneumonia, sinusitis, and bronchitis. Prescriptions for broad-spectrum antibiotics declined following the intervention including decreases in levofloxacin from 12 (9%) to 3 (3%) and amoxicillin-clavulanate from 15 (12%) to 7 (7%). We detected significant reductions in prescribed antibiotic durations (days) after the intervention for sinusitis (estimate, -2.0; 95% CI, -3.1 to -1.0; P = .0003), pharyngitis (estimate, -2.5; 95% CI, -4.6 to -0.5; P = .018), and otitis (-3.2; 95% CI, -5.2 to -1.3; P = .008).
Conclusions:
Low-cost interventions were initially successful in changing patterns of antibiotic use and decreasing overall antibiotic prescribing among older patients in the outpatient setting. Long-term follow-up studies are needed to determine the sustainability and clinical impact of these interventions.
Insights
Quality improvement initiatives reduced inappropriate antibiotic prescribing in older adults. Interventions included provider education and electronic order sets, leading to decreased overall antibiotic use and shorter prescription durations.
Area of Science:
- Geriatric Medicine
- Infectious Diseases
- Public Health
Background:
- Over 80% of antibiotics are prescribed outpatient, with 30% being inappropriate.
- Inappropriate antibiotic use is linked to adverse reactions and Clostridioides difficile infections, particularly in older adults.
- National goals aim to reduce outpatient antibiotic use by 50% by 2020.
Purpose of the Study:
- To evaluate the effectiveness of a quality improvement initiative in reducing antibiotic prescribing in an outpatient geriatric clinic.
- To assess changes in the overall number and duration of antibiotic prescriptions for acute respiratory conditions.
Main Methods:
- A before-and-after study design was employed at the University of Colorado Seniors Clinic.
- Interventions included provider education on antibiotic guidelines and implementation of electronic antibiotic order sets with standardized stop dates.
- Antibiotic use data were collected for six months pre- and post-intervention, with statistical analysis using descriptive statistics and linear mixed-effects regression models.
Main Results:
- Total antibiotic prescriptions for acute respiratory conditions decreased from 137 to 112.
- Prescriptions for broad-spectrum antibiotics, including levofloxacin and amoxicillin-clavulanate, declined.
- Significant reductions in prescribed antibiotic durations were observed for sinusitis, pharyngitis, and otitis.
Conclusions:
- Low-cost interventions successfully altered antibiotic prescribing patterns in older outpatient populations.
- The initiative demonstrated initial success in decreasing overall antibiotic prescribing.
- Further long-term studies are necessary to confirm the sustainability and clinical impact of these interventions.
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