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Variability in Antimicrobial Prescribing Across Five Ambulatory Settings Within a Large Integrated Health System.

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Antibiotic prescribing rates in ambulatory care settings were similar to national averages. Variability in prescribing highlights opportunities for targeted antibiotic stewardship programs to improve antimicrobial use.

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Area of Science:

  • Infectious Diseases
  • Public Health
  • Health Services Research

Background:

  • Limited access to timely antibiotic use data hinders ambulatory antibiotic stewardship.
  • Antibiotic utilization tracking is crucial across various outpatient settings and emergency departments.
  • Integrated health systems provide a platform for comprehensive antibiotic use analysis.

Purpose of the Study:

  • To analyze antibiotic prescribing patterns in common outpatient infections.
  • To compare antibiotic use across different ambulatory care settings.
  • To identify opportunities for antimicrobial stewardship interventions.

Main Methods:

  • Retrospective cohort analysis of antibiotic prescribing for cystitis, otitis media, pharyngitis, sinusitis, and URTIs.
  • Data collected from June 2019 to May 2020 across five care departments: ED, UC, TEL, PED, and PC.
  • Comparison of antibiotic prescribing rates and guideline concordance across different care settings.

Main Results:

  • Over 261,000 encounters analyzed, with antibiotics prescribed in 44% of cases.
  • Guideline-concordant antibiotic prescribing varied by setting, ranging from 51% in PC to 84% in TEL.
  • Prescribing rates were comparable to national ambulatory care benchmarks.

Conclusions:

  • Antibiotic prescribing patterns in this health system align with national trends.
  • Significant variability in prescribing indicates potential for targeted outpatient stewardship.
  • Implementing timely antibiotic tracking tools can enhance ambulatory antimicrobial stewardship efforts.