A Multifaceted Intervention Improves Prescribing for Acute Respiratory Infection for Adults and Children in Emergency Department and Urgent Care Settings

Details

• Alternative Title:
  Acad Emerg Med
• Personal Author:
  Yadav, Kabir ; Meeker, Daniella ; Mistry, Rakesh D. ; Doctor, Jason N. ; Fleming-Dutra, Katherine E. ; Fleischman, Ross J. ; Gaona, Samuel D. ; Stahmer, Aubyn ; May, Larissa
• Description:
  Background:
  
  Antibiotics are commonly prescribed during emergency department (ED) and urgent care center (UCC) visits for viral acute respiratory infection (ARI). We evaluate the comparative effectiveness of an antibiotic stewardship intervention adapted for acute care ambulatory settings (adapted intervention) to a stewardship intervention that additionally incorporates behavioral nudges (enhanced intervention) in reducing inappropriate prescriptions.
  
  Methods:
  
  Pragmatic, cluster randomized clinical trial conducted in three academic health systems comprising five adult and pediatric EDs and four UCCs. Randomization of the nine sites was stratified by health system; all providers at each site either received the adapted or enhanced intervention. The main outcome was the proportion of antibiotic inappropriate ARI diagnosis visits that received an outpatient antibiotic prescription by individual providers. We estimated a hierarchical mixed effects logistic regression model comparing visits during the influenza season for 2016–2017 (baseline) and 2017–2018 (intervention).
  
  Results:
  
  There were 44,820 ARI visits among 292 providers across all nine cluster sites. Antibiotic prescribing for ARI visits dropped from 6.2% (95% CI: 4.5 – 7.9%) to 2.4% (95% CI:1.3 – 3.4%) during the study period. We found a significant reduction in inappropriate prescribing after adjusting for health-system and provider-level effects from 2.2% (95% CI: 1.0 – 3.4%) to 1.5% (95% CI: 0.7 – 2.3%) with an odds ratio of 0.67 (95% CI: 0.54 – 0.82). Difference-in-differences between the two interventions was not significantly different.
  
  Conclusion:
  
  Implementation of antibiotic stewardship for ARI is feasible and effective in the ED and UCC settings. More intensive behavioral nudging methods were not more effective in high-performance settings.
  
  
• Subjects:
  Adult Ambulatory Care Anti-Bacterial Agents Antimicrobial Stewardship Attitude Of Health Personnel Child Emergency Service, Hospital Female Humans Inappropriate Prescribing Logistic Models Male Practice Patterns, Physicians' Program Evaluation Respiratory Tract Infections

  More +
• Source:
  Acad Emerg Med. 26(7):719-731
• Pubmed ID:
  31215721
• Pubmed Central ID:
  PMC8146207
• Document Type:
  Journal Article
• Funding:
  R21 AG057400/AG/NIA NIH HHSUnited States/ ; 200-2016-91939/CC/CDC HHSUnited States/
• Volume:
  26
• Issue:
  7
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:f9c0b9d074c6139c2f8332c84ef9ffdec7310460a52b8ebc632047286b4136ab
• Download URL:
  https://stacks.cdc.gov/view/cdc/106606/cdc_106606_DS1.pdf
• File Type:
  [PDF - 987.79 KB ]