Background: Antibiotic stewardship (AS) has historically focused on inpatient facilities and primary care clinics; many antibiotics (ABx) are prescribed in urgent care clinics (UCCs). However, few centers have described implementing AS in such settings. We sought to reduce total ABx use in our UCCs as well as specifically decrease azithromycin use.
Methods: We conducted this study in 4 UCCs owned by a large community-based academic healthcare system in northern Delaware. The UCCs average >65,000 visits annually and include 38 providers (physicians, physician assistants and nurse practitioners). A new electronic health record was implemented in Oct 2016; ABx utilization data are not available prior to this time. Beginning in Jan 2017, all providers received in-person education on guideline-recommended management of common infectious diseases, including bronchitis, sinusitis and pharyngitis. The lead physician performed chart audits and provided group and individual education and feedback via email and telephone. Individual ABx utilization rates were not provided, but documentation of rationale for ABx need was emphasized. Patient education included ABx links on the check-in website, posters in waiting and exams rooms, and patient education materials embedded within each discharge packet, with an emphasis on providing evidence-based care rather than denying ABx. We calculated number of total ABx prescriptions (Rx) and of azithromycin Rx per 100 visits per month, and calculated rate ratios comparing Jan 2017 (pre-intervention) to Jan 2018 (post).
Results: During the 16-month intervention period, total ABx use declined from 67 Rx per 100 visits to 44/100 visits (rate ratio, 0.55, 95%CI 0.37-0.80) and azithromycin use declined from 13 Rx/100 visits to 5/100 visits (RR 0.32, 95% CI 0.10-0.88). Seasonal variability was apparent (Figure).
Conclusion: A multifaceted educational approach positively impacted provider behaviors and patient expectations, and did not rely upon providing ABx utilization data (either clinic- or individual-level). Ensuring leadership support of providers if patients expressed dissatisfaction and standardized messaging and tools were critical for managing patient expectations.
H. P. Kramer,
M. Winiarz, None
C. M. Coletti, None
E. F. Ewen, None
M. Drees, None