1898. Evaluation of an Audit and Feedback Intervention to Improve Acute Respiratory Tract (ARI) Antibiotic Prescribing in Outpatients
Session: Poster Abstract Session: Antibiotic Stewardship: Outpatient and ED
Saturday, October 29, 2016
Room: Poster Hall
Background: Antibiotic overuse is associated with the development of drug-resistant organisms and may confer unnecessary adverse effects to patients. The largest component of inappropriate antibiotic use in outpatient settings is for Acute Respiratory tract Infections (ARIs) including: sinusitis (S), pharyngitis (P), bronchitis (B), and the common cold (CC). In 2015-16 we implemented a multi-faceted approach to improve ARI management including the 5 core elements of outpatient antibiotic stewardship: commitment, action, tracking, reporting, and education.
Methods: Commitment: Support for improvement in ARI management was publicly stated by leadership during a facility-wide educational event. Action: Individualized academic detailing and audit and feedback of prescribing patterns for providers with > 20 ARI encounters annually; and facility-wide introduction of computerized ARI specific management menus. Tracking: Provider-specific ARI management reports including antibiotic prescribing and menu use rates. Reporting: Monthly provider-specific audit and feedback reports distributed by team champions/pharmacists. Education: Facility-wide provider (group) education on ARI management and patient-materials available in clinic. Audit and Feedback reports compared individual performance to the top 20% of prescribers. Antibiotic appropriateness was defined as 1st/2nd line therapies for S or P (with positive RADT) and no antibiotic therapy for B or CC. Retrospective review and electronic data capture were used to characterize outpatient ARI visits during the 2014-15 and 2015-16 ARI seasons.
Results: Appropriateness of prescribing improved from 63.2% to 75.9% (p<0.0001) compared to 2014-15, with a 23.5% reduction in antibiotics for any ARI. Audit and feedback recipients had improvement in appropriateness of prescribing (80.6% v 70.8%, p<0.01), and were more likely to use computerized ARI specific menus (18.7% v 10.3%, p<0.01), as compared to recipients of education and access to ARI specific order menus alone.
Conclusion: Individualized academic detailing coupled with audit and feedback promotes a reduction in inappropriate antibiotic prescribing for ARIs more than education or the availability ofARI specific order menu alone.
Lindsey Hunt, Pharm.D.1, Jefferson Bohan, PharmD1, Robert Mckie, MD1, Ashley Farley, PharmD Candidate2 and Karl Madaras-Kelly, PharmD., MPH1,2, (1)Vet. Med. Ctr., Boise, ID, (2)Coll. of Pharmacy, Idaho State Univ., Meridian, ID
None R. Mckie,
None A. Farley,
None K. Madaras-Kelly,