Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-22T23:10:49.320Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of an electronic best-practice advisory in combination with prescriber education on antibiotic prescribing for ambulatory adults with acute, uncomplicated bronchitis within a large integrated health system

Published online by Cambridge University Press:  21 October 2019

Courtney M. Pagels ,
Thomas J. Dilworth Open the ORCID record for Thomas J. Dilworth [Opens in a new window] ,
Lynne Fehrenbacher ,
Maharaj Singh  and
Charles F. Brummitt
Courtney M. Pagels
Affiliation:
AdvocateAuroraHealth, Milwaukee, Wisconsin
Thomas J. Dilworth*
Affiliation:
AdvocateAuroraHealth, Milwaukee, Wisconsin
Lynne Fehrenbacher
Affiliation:
Concordia University Wisconsin School of Pharmacy, Mequon, Wisconsin
Maharaj Singh
Affiliation:
Marquette University, School of Dentistry, Milwaukee, Wisconsin
Charles F. Brummitt
Affiliation:
AdvocateAuroraHealth, Milwaukee, Wisconsin
*
Author for correspondence: Thomas J. Dilworth, Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine the impact of a passive, prescriber-directed, electronic best-practice advisory coupled with prescriber education on the rate of antibiotic prescribing for acute, uncomplicated bronchitis in ambulatory adults across a large health system.

Design:

This study was a quasi-experiment examining antibiotic prescribing for ambulatory adults with acute bronchitis from January 1, 2016 through December 31, 2018. The intervention was implemented in December 2016 for emergency departments and urgent care clinics followed by ambulatory clinics in September 2017.

Setting:

Outpatient settings across a health system, including 15 emergency departments, >30 urgent care clinics, and >150 ambulatory clinics.

Participants:

All adults with a primary diagnosis of acute bronchitis who were seen and discharged from a study site were included.

Interventions:

A passive, prescriber-directed, best-practice advisory for treatment of acute bronchitis in the electronic health record and an optional, online education module regarding acute bronchitis.

Results:

The study included 81,975 ambulatory adults with a primary diagnosis of acute bronchitis during the preintervention period (19.8% >65 years of age; 61.9% female) and 89,571 ambulatory adults during the postintervention period (16.5% >65 years of age; 61.1% female). Antibiotic prescribing rates decreased from 60.8% (49,877 of 81,975 patients) preintervention to 51.4% (46,018 of 89,571 patients) postintervention (absolute difference, 9.4%; P < .001). The largest reduction occurred in the emergency departments.

Conclusions:

An electronic best practice advisory combined with prescriber education was associated with a statistically significant reduction in antibiotic prescribing for adults with acute bronchitis. Future studies should incorporate patient education and address prescriber-reported barriers to appropriate antibiotic prescribing.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 12 , December 2019 , pp. 1348 - 1355
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION: This work was presented in part as poster no. 179 at IDWeek 2018 on October 4, 2018, in San Francisco, California.

References

Gonzales, R, Bartlett, JG, Besser, RE, et al. Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis: background. Ann Intern Med 2001;134:521–529.CrossRefGoogle ScholarPubMed
Harris, AM, Hicks, LA, Qaseem, A. Appropriate antibiotic use for acute respiratory tract infection in adults. Ann Intern Med 2016;165:674.CrossRefGoogle ScholarPubMed
Joint statement on importance of outpatient antibiotic stewardship from 12 national health organizations. Centers for Disease Control and Prevention website. https://www.cdc.gov/getsmart/community/partners/joint-statement.html. Published October 5, 2016. Accessed October 31, 2017.Google Scholar
Smith, SM, Fahey, T, Smucny, J, Becker, LA. Antibiotics for acute bronchitis. Cochrane Database Syst Rev 2017;6:CD000245.Google ScholarPubMed
The state of health care quality 2017. National Center for Quality Assurance website. http://www.ncqa.org/report-cards/health-plans/state-of-health-care-quality/2017-table-of-contents/apc. Accessed May 3, 2018.Google Scholar
National action plan for combating antibiotic-resistant bacteria. The White House website. https://obamawhitehouse.archives.gov/sites/default/files/docs/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf. Published March 2015. Accessed October 31, 2017.Google Scholar
Sanchez, GV, Fleming-dutra, KE, Roberts, RM, Hicks, LA. Core elements of outpatient antibiotic stewardship. MMWR Recomm Rep 2016;65:1–12.CrossRefGoogle ScholarPubMed
Litvin, CB, Ornstein, SM, Wessell, AM, Nemeth, LS, Nietert, PJ. Use of an electronic health record clinical decision support tool to improve antibiotic prescribing for acute respiratory infections: the ABX-TRIP study. J Gen Intern Med 2013;28:810–816.CrossRefGoogle ScholarPubMed
Gerber, JS, Prasad, PA, Fiks, AG, et al. Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians. JAMA 2013;309:2345–2352.CrossRefGoogle ScholarPubMed
Meeker, D, Linder, JA, Fox, CR, et al. Effect of behavioral interventions on inappropriate antibiotic prescribing among primary care practices: a randomized clinical trial. JAMA 2016;315:562–570.CrossRefGoogle ScholarPubMed
Linder, JA, Meeker, D, Fox, CR, et al. Effects of behavioral interventions on inappropriate antibiotic prescribing in primary care 12 months after stopping interventions. JAMA 2017;318:1391.CrossRefGoogle ScholarPubMed
Gifford, J, Vaeth, E, Richards, K, et al. Decision support during electronic prescription to stem antibiotic overuse for acute respiratory infections: a long-term, quasi-experimental study. BMC Infect Dis 2017;17:528.CrossRefGoogle ScholarPubMed
Sharp, AL, Hu, YR, Shen, E, et al. Improving antibiotic stewardship: a stepped wedge cluster randomized trial. Am J Manag Care 2017;23:e360–e365.Google ScholarPubMed
Hansen, MJ, Carson, PJ, Leedahl, DD, Leedahl, ND. Failure of a best practice alert to reduce antibiotic prescribing rates for acute sinusitis across an integrated health system in the midwest. J Manag Care Spec Pharm 2018;24:154–159.Google Scholar
Palms, DL, Hicks, LA, Bartoces, M, et al. Comparison of antibiotic prescribing in retail clinics, urgent care centers, emergency departments, and traditional ambulatory care settings in the United States. JAMA Intern Med 2018;178:1267–1269.CrossRefGoogle ScholarPubMed
Link, TL, Townsend, ML, Leung, E, Kommu, S, Vega, RY, Hendrix, CC. Reducing inappropriate antibiotic prescribing for adults with acute bronchitis in an urgent care setting: a quality improvement initiative. Adv Emerg Nurs J 2016;38:327–335.CrossRefGoogle Scholar
Hashimoto, H, Matsui, H, Sasabuchi, Y, et al. Antibiotic prescription among outpatients in a prefecture of Japan, 2012–2013: a retrospective claims database study. BMJ Open 2019;9:e026251.CrossRefGoogle Scholar
Gonzales, R, Anderer, T, McCulloch, CE, et al. A cluster randomized trial of decision support strategies for reducing antibiotic use in acute bronchitis. JAMA Intern Med 2013;173:267–273.CrossRefGoogle ScholarPubMed
Ackerman, SL, Gonzales, R, Stahl, MS, Metlay, JP. One size does not fit all: Evaluating an intervention to reduce antibiotic prescribing for acute bronchitis. BMC Health Serv Res 2013;13:462.CrossRefGoogle Scholar
Ong, S, Nakase, J, Moran, GJ, et al. Antibiotic use for emergency department patients with upper respiratory infections: prescribing practices, patient expectations, and patient satisfaction. Ann Emerg Med 2007;50:213–220.CrossRefGoogle ScholarPubMed
Jung, S, Sexton, ME, Owens, S, Spell, N, Fridkin, S. Variability of antibiotic prescribing in a large healthcare network despite adjusting for patient-mix: reconsidering targets for improved prescribing. Open Forum Infect Dis 2019;6(2):ofz018.CrossRefGoogle Scholar
Roth, S, Gonzales, R, Harding-Anderer, T, et al. Unintended consequences of a quality measure for acute bronchitis. Am J Manag Care 2012;18:217–224.Google ScholarPubMed
Supplementary material: PDF

Pagels et al. supplementary material

Pagels et al. supplementary material 1

Download Pagels et al. supplementary material(PDF)
PDF 129.9 KB
Supplementary material: File

Pagels et al. supplementary material

Pagels et al. supplementary material 2

Download Pagels et al. supplementary material(File)
File 13.7 KB