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Outcomes of an ambulatory care pharmacist-led antimicrobial stewardship program within a family medicine resident clinic

Published online by Cambridge University Press:  13 November 2020

Lindsey R. Westerhof Open the ORCID record for Lindsey R. Westerhof [Opens in a new window] ,
Lisa E. Dumkow ,
Tarajo L. Hanrahan ,
Samantha V. McPharlin  and
Nnaemeka E. Egwuatu
Lindsey R. Westerhof*
Affiliation:
Mercy Health Saint Mary’s Health System, Department of Pharmacy, Grand Rapids, Michigan
Lisa E. Dumkow
Affiliation:
Mercy Health Saint Mary’s Health System, Department of Pharmacy, Grand Rapids, Michigan
Tarajo L. Hanrahan
Affiliation:
Mercy Health Saint Mary’s Health System, Department of Family Medicine, Residency Center Grand Rapids, Michigan
Samantha V. McPharlin
Affiliation:
Mercy Health Saint Mary’s Health System, Department of Family Medicine, Residency Center Grand Rapids, Michigan
Nnaemeka E. Egwuatu
Affiliation:
Mercy Health Saint Mary’s Health System, Department of Infectious Diseases, Grand Rapids, Michigan
*
Author for correspondence: Lindsey R. Westerhof, E-mail: [email protected]
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Abstract

Objective:

To determine whether an ambulatory care pharmacist (AMCP)-led intervention improved outpatient antibiotic prescribing in a family medicine residency clinic (FMRC) for upper respiratory tract infections (URIs), urinary tract infections (UTIs), and skin and soft-tissue infections (SSTIs).

Design:

Retrospective, quasi-experimental study comparing guideline-concordant antibiotic prescribing before and after an antimicrobial stewardship program (ASP) intervention.

Setting:

Family medicine residency clinic affiliated with a community teaching hospital.

Participants:

Adult and pediatric patients prescribed antibiotics for URI, UTI, or SSTI between November 1, 2017, and April 31, 2018 (pre-ASP group), or October 1, 2018, and March 31, 2019 (ASP group), were eligible for inclusion.

Methods:

The health-system ASP physician and pharmacist provided live education and pocket cards to FMRC staff with local guidelines as a quick reference. Audit with feedback was delivered every other week by the clinic’s AMCP. Guideline-concordance was determined based on the institution’s outpatient ASP guidelines.

Results:

Overall, 525 antibiotic prescriptions were audited (pre-ASP n = 90 and ASP n = 435). Total guideline-concordant antibiotic prescribing at baseline was 38.9% (URI, 53.3%; SSTI, 16.7%; UTI, 46.7%) and improved across all 3 infection types to 57.9% (URI, 61.2%; SSTI, 57.6%; UTI, 53.5%; P = .001). Significant improvements were seen in guideline-concordant antibiotic selection (68.9% vs 80.2%; P = .018), dose (76.7% vs 86.2%; P = .023), and duration of therapy (73.3% vs 86.2%; P = .02).

Conclusions:

An AMCP-led outpatient ASP intervention significantly improved guideline-concordant antibiotic prescribing for common infections within a FMRC.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 6 , June 2021 , pp. 715 - 721
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Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION: Preliminary data were presented at the Michigan Family Medicine Research Day Conference On May 23, 2019, in Howell, Michigan, and an abstract of this work was accepted as a poster presentation at ECCMID 2020 on April 20, 2020, in Paris, France; it was published online only because the conference was canceled due to COVID-19.

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