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- Title
Impact of Implementation of the Core Elements of Outpatient Antibiotic Stewardship Within Veterans Health Administration Emergency Departments and Primary Care Clinics on Antibiotic Prescribing and Patient Outcomes.
- Authors
Madaras-Kelly, Karl; Hostler, Christopher; Townsend, Mary; Potter, Emily M; Spivak, Emily S; Hall, Sarah K; Goetz, Matthew Bidwell; Nevers, McKenna; Ying, Jian; Haaland, Benjamin; Rovelsky, Suzette A; Pontefract, Benjamin; Fleming-Dutra, Katherine; Hicks, Lauri A; Samore, Matthew H
- Abstract
Background The Core Elements of Outpatient Antibiotic Stewardship provide a framework to improve antibiotic use. We report the impact of core elements implementation within Veterans Health Administration sites. Methods In this quasiexperimental controlled study, effects of an intervention targeting antibiotic prescription for uncomplicated acute respiratory tract infections (ARIs) were assessed. Outcomes included per-visit antibiotic prescribing, treatment appropriateness, ARI revisits, hospitalization, and ARI diagnostic changes over a 3-year pre-implementation period and 1-year post-implementation period. Logistic regression adjusted for covariates (odds ratio [OR], 95% confidence interval [CI]) and a difference-in-differences analysis compared outcomes between intervention and control sites. Results From 2014–2019, there were 16 712 and 51 275 patient visits within 10 intervention and 40 control sites, respectively. Antibiotic prescribing rates pre- and post-implementation within intervention sites were 59.7% and 41.5%, compared to 73.5% and 67.2% within control sites, respectively (difference-in-differences, P <.001). Intervention site pre- and post-implementation OR to receive appropriate therapy increased (OR, 1.67; 95% CI, 1.31–2.14), which remained unchanged within control sites (OR,1.04; 95% CI,.91–1.19). ARI-related return visits post-implementation (–1.3% vs –2.0%; difference-in-differences P =.76) were not different, but all-cause hospitalization was lower within intervention sites (–0.5% vs –0.2%; difference-in-differences P =.02). The OR to diagnose non-specific ARI compared with non-ARI diagnoses increased post-implementation forintervention (OR, 1.27; 95% CI, 1.21 –1.34) but not control (OR, 0.97; 95% CI,.94–1.01) sites. Conclusions Implementation of the core elements was associated with reduced antibiotic prescribing for RIs and a reduction in hospitalizations. Diagnostic coding changes were observed.
- Subjects
ANTIBIOTICS; ANTIMICROBIAL stewardship; VETERANS' hospitals; EVALUATION of medical care; PATIENT aftercare; RESEARCH; HOSPITAL emergency services; CLINICAL trials; EVALUATION of human services programs; CONFIDENCE intervals; RESEARCH methodology; ANTI-infective agents; RESPIRATORY infections; MEDICAL cooperation; PRIMARY health care; HUMAN services programs; PRE-tests &; post-tests; COMPARATIVE studies; DRUG prescribing; DESCRIPTIVE statistics; HOSPITAL care; PHYSICIAN practice patterns; CONTROL groups; MEDICAL appointments; LOGISTIC regression analysis; ODDS ratio; MEDICAL prescriptions; ACUTE diseases; LONGITUDINAL method; EVALUATION
- Publication
Clinical Infectious Diseases, 2021, Vol 73, Issue 5, pe1126
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciaa1831