Implementation and outcomes of a clinician-directed intervention to improve antibiotic prescribing for acute respiratory tract infections within the Veterans’ Affairs Healthcare System

Details

• Alternative Title:
  Infect Control Hosp Epidemiol
• Personal Author:
  Madaras-Kelly, Karl J. ; Rovelsky, Suzette A. ; McKie, Robert A. ; Nevers, McKenna R. ; Ying, Jian ; Haaland, Benjamin A. ; Kay, Chad L. ; Christopher, Melissa L. ; Hicks, Lauri A. ; Samore, Mathew H.
• Description:
  Objective: ; To determine whether a clinician-directed acute respiratory tract infection (ARI) intervention was associated with improved antibiotic prescribing and patient outcomes across a large US healthcare system. ; Design: ; Multicenter retrospective quasi-experimental analysis of outpatient visits with a diagnosis of uncomplicated ARI over a 7-year period. ; Participants: ; Outpatients with ARI diagnoses: sinusitis, pharyngitis, bronchitis, and unspecified upper respiratory tract infection (URI-NOS). Outpatients with concurrent infection or select comorbid conditions were excluded. ; Intervention(s): ; Audit and feedback with peer comparison of antibiotic prescribing rates and academic detailing of clinicians with frequent ARI visits. Antimicrobial stewards and academic detailing personnel delivered the intervention; facility and clinician participation were voluntary. ; Measure(s): ; We calculated the probability to receive antibiotics for an ARI before and after implementation. Secondary outcomes included probability for a return clinic visits or infection-related hospitalization, before and after implementation. Intervention effects were assessed with logistic generalized estimating equation models. Facility participation was tracked, and results were stratified by quartile of facility intervention intensity. ; Results: ; We reviewed 1,003,509 and 323,023 uncomplicated ARI visits before and after the implementation of the intervention, respectively. The probability to receive antibiotics for ARI decreased after implementation (odds ratio OR, 0.82; 95% confidence interval CI, 0.78–0.86). Facilities with the highest quartile of intervention intensity demonstrated larger reductions in antibiotic prescribing (OR, 0.69; 95% CI, 0.59–0.80) compared to nonparticipating facilities (OR, 0.89; 95% CI, 0.73–1.09). Return visits (OR, 1.00; 95% CI, 0.94–1.07) and infection-related hospitalizations (OR, 1.21; 95% CI, 0.92–1.59) were not different before and after implementation within facilities that performed intensive implementation. ; Conclusions: ; Implementation of a nationwide ARI management intervention (ie, audit and feedback with academic detailing) was associated with improved ARI management in an intervention intensity–dependent manner. No impact on ARI-related clinical outcomes was observed.
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• Keywords:
  • Humans
  • Anti-Bacterial Agents
  • Retrospective Studies
  • Veterans
  • Practice Patterns, Physicians'
  • Respiratory Tract Infections
  • Multicenter Studies as Topic
• Source:
  Infect Control Hosp Epidemiol. 44(5):746-754
• Pubmed ID:
  35968847
• Pubmed Central ID:
  PMC10882581
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  44
• Issue:
  5
• Download URL:
  https://stacks.cdc.gov/view/cdc/150315/cdc_150315_DS1.pdf
• File Type:
  [PDF - 566.39 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:0c5f58762d631b47bc1f58e4c515367f31e246ea97337ad73fe97572a6c583ab