213. Multi-centered Evaluation of an Acute Respiratory Tract Infection Audit-Feedback Intervention: Impact on Antibiotic Prescribing Rates and Patient Outcomes
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions to Improve Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
  • ARI_ID_Week_2018_Poster_#213.pdf (664.6 kB)
  • Background: Audit-feedback of antibiotic prescribing rates for acute respiratory infections (ARIs) is a promising approach to reduce antibiotic use; however, the generalizability and sustainability are unknown. We describe an audit-feedback intervention and outcomes across multiple seasons in different clinic settings.

    Methods: Two VA Medical Centers distributed audit-feedback reports targeting providers with frequent ARI visits in emergency department (ED) and primary care (PC) during 2015-16 and 2016-17. An academic detailing visit delivered by local peers accompanied the initial audit-feedback report. The intervention was expanded to ED and PC clinics (n=10) in three other VA facilities in 2017-18. Outcomes included rates of antibiotics prescribed, recurrent visits for ARIs within 30 days, and adverse events. We assessed intervention sustainability in initiating VAs, and intervention generalizability in expansion VAs. Mixed-effect logistic regression models were used to assess intervention effect on antibiotic prescribing and outcomes.

    Results: Antibiotic prescribing for uncomplicated ARI visits (n=7814) declined from 53.8% to 27.9% post intervention. The intervention was associated with a reduction in odds of prescribing antibiotics in initiating facilities (Odds Ratio [OR] 0.6 (95% CI 0.3, 0.9), which declined further with an annual OR 0.8 [95% CI 0.7, 1.1] per year. Preliminary 6-month post-intervention results were available from pilot clinics (n=3) within two of the expansion VAs, which indicated similar effectiveness (OR 0.5 [0.4, 0.7]). Recurrent visits for ARIs (8.2% vs. 8.6%, p=0.14) and adverse events (2.3% vs. 2.1%, p=0.90) were not different pre/post intervention. Receipt of an antibiotic was not associated with recurrent visits for ARI (8.6% vs. 8.0%, p=0.45) or adverse events (1.9% vs. 1.7%, p=0.11).

    Conclusion: An audit-feedback intervention sustained a reduction in antibiotic prescribing for ARIs over three years, and resulted in similar reductions in antibiotic use in varied ED and PC settings without affecting ARI-related return visit rates.

    Karl Madaras-Kelly, PharmD, MPH, Pharmacy Service, Boise Veterans Affairs Medical Center, Boise, ID; Pharmacy Practice, College of Pharmacy, Idaho State University, Meridian, ID, Hayli Hruza, MPH, Pharmacy, Boise VA Medical Center, Boise, ID, Benjamin Pontefract, PharmD, Pharmacy, Boise Veteran Affairs Medical Center, Boise, ID, Robert Mckie, MD, Vet. Med. Ctr., Boise, ID, Christopher Hostler, MD, MPH, Infectious Diseases Section, Durham VA Health Care System, Durham, NC, Mary Townsend, PharmD, AAHIVP, Durham VA Medical Center, Durham, NC, Emily M. Potter, PharmD, Dwight D. Eisenhower Veterans Affairs Medical Center, Leavenworth, KS, Emily Spivak, MD, MHS, Internal Medicine, University of Utah Health, Salt Lake City, UT, Sarah Hall, MD, VA Salt Lake City Healthcare System, Salt Lake City, UT, Matthew Goetz, MD, Infectious Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA, McKenna Nevers, MS, Salt Lake City Veteran Affairs Medical Center, Salt Lake City, UT, Jian Ying, PhD, Medicine, University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT, Ben Haaland, PhD, University of Utah, School of Medicine, Salt Lake City, UT, Katherine Fleming-Dutra, MD, CDC, Atlanta, GA and Matthew Samore, MD, FSHEA, University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT


    K. Madaras-Kelly, None

    H. Hruza, None

    B. Pontefract, None

    R. Mckie, None

    C. Hostler, None

    M. Townsend, None

    E. M. Potter, None

    E. Spivak, None

    S. Hall, None

    M. Goetz, None

    M. Nevers, None

    J. Ying, None

    B. Haaland, None

    K. Fleming-Dutra, None

    M. Samore, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.