Methods: The objective of this study was to determine the impact of commitment posters as a single-intervention in rural outpatient clinics on antibiotic prescribing for upper respiratory tract infections (URIs). This was a quasi-experimental study performed at The Guthrie Clinic, a network of outpatient clinics located in rural New York and Pennsylvania. Commitment posters were displayed in examination and waiting rooms of outpatient clinics (n=19) between April-June 2017 (intervention period). Patients with a URI visit diagnosis code during the period of July 1, 2016-December 31, 2016 (pre-intervention) and July 1, 2017-December 31, 2017 (post-intervention) were included. Demographic, provider, clinic, and antibiotic prescription data were collected.
Results: A total of 4,422 and 3,830 URI cases were diagnosed, and antibiotics were prescribed for 2,406 and 1,969 cases in the pre- and post-intervention periods, respectively. Fewer antibiotics were prescribed for URI cases in the post-intervention period compared to pre-intervention (54.6% vs. 51.6%, p=0.013). The most commonly prescribed antibiotics in both cohorts were amoxicillin, amoxicillin-clavulanate, and azithromycin. Male gender (p=0.0045), older age (p<0.001), and patients who were seen by a provider other than their primary care provider (p=0.001), were associated with a higher proportion of antibiotics prescribed per URI diagnosis. There was no statistically significant difference in antibiotics prescribed for patients with and without certain comorbidities such as diabetes or chronic obstructive pulmonary disease.
Conclusion: Antibiotic stewardship commitment posters were associated with a decrease in the number of antibiotics prescribed for URIs in rural clinics and represent a low-hanging fruit intervention for outpatient antibiotic stewardship programs, particularly in rural settings.
U. Dang, None
C. Cushna, None
K. Bohan, None