Impact of a Medication Reconciliation Pharmacist Program on Appropriateness of Community-Acquired Pneumonia Treatment
Cayla M Pelle1, Steven C Berger1, Marintha R Short1
1Saint Joseph East, Lexington, KY, USA.
Background:
Antimicrobial stewardship programs have made large efforts to minimize the inappropriate use of antibiotics. Implementation of these programs can be challenging, since many institutions have limited resources. Utilizing resources that already exist may be beneficial, including medication reconciliation pharmacist (MRP) programs. This study aims to evaluate the impact of a MRP program on appropriateness of community-acquired pneumonia (CAP) treatment durations at hospital discharge.
Methods:
This study was a retrospective, observational, single-center study comparing the total days of antibiotic therapy for CAP in the preintervention period (9/2020-11/2020) versus the post-intervention period (9/2021-11/2021). Implementation of a new clinical intervention occurred between the 2 periods and included education to MRPs on appropriate CAP treatment durations and on documentation of recommendations. Data was collected utilizing a chart review of the electronic medical record of patients diagnosed with CAP using ICD-10 codes. The primary objective of this study was to compare the total days of antibiotic therapy in the pre-intervention period versus the postintervention period.
Results:
One-hundred fifty-five patients were included in the primary analysis. When observing total days of antibiotic therapy, there was no change from the pre-intervention period at 8 days compared to the postintervention period (P = .109). When analyzing antibiotic days of therapy at discharge, there was a decrease from 4.55 days in the preintervention period compared to 3.8 days in the post-intervention period (P = .109). The incidence of those with appropriate treatment durations, defined as 5 to 7 days of antibiotic therapy, was higher in the post-intervention period (26.5% in the pre-intervention group vs 37.9% in the post-intervention group, P = .460).
Conclusions:
There was a non-statistically significant decrease in median days of antimicrobial therapy for CAP at hospital discharge after implementation of a new clinical intervention targeting antibiotic days of therapy. Though median total antibiotic days of therapy were similar between both time periods, patients had an overall increase in incidence of appropriate duration of therapy, defined as 5 to 7 days, after intervention. Further studies are necessary to show how MRPs have a positive impact on improving outpatient antibiotic prescribing at hospital discharge.
Insights
Medication reconciliation pharmacist (MRP) programs can improve antibiotic use for community-acquired pneumonia (CAP). While total antibiotic days didn't change, appropriate discharge durations increased after MRP education, suggesting potential for better outpatient prescribing.
Area of Science:
- Infectious Diseases
- Pharmacology
- Health Services Research
Background:
- Antimicrobial stewardship programs aim to reduce antibiotic misuse.
- Implementation challenges exist due to limited resources.
- Leveraging existing resources like medication reconciliation pharmacist (MRP) programs is a potential solution.
Purpose of the Study:
- To evaluate the impact of an MRP program on the appropriateness of community-acquired pneumonia (CAP) treatment durations at hospital discharge.
- To assess changes in antibiotic therapy days before and after intervention.
Main Methods:
- Retrospective, observational, single-center study.
- Comparison of antibiotic therapy days for CAP in pre-intervention (9/2020-11/2020) and post-intervention (9/2021-11/2021) periods.
- Intervention included education for MRPs on appropriate CAP treatment durations and documentation.
Main Results:
- No significant change in total antibiotic days of therapy (8 days pre- vs. post-intervention).
- A decrease in antibiotic days of therapy at discharge (4.55 days pre- vs. 3.8 days post-intervention).
- Increased incidence of appropriate treatment durations (5-7 days) in the post-intervention period (37.9% vs. 26.5%).
Conclusions:
- A non-statistically significant decrease in median antibiotic therapy days for CAP at discharge was observed post-intervention.
- The incidence of appropriate antibiotic therapy durations (5-7 days) increased after the MRP intervention.
- Further research is needed to confirm the positive impact of MRPs on outpatient antibiotic prescribing at hospital discharge.
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