Background: We report VA-wide trends over time in acute respiratory infection (ARI) antibiotic prescribing, and early assessment of an intervention to improve ARI management.
Methods: We created a retrospective cohort of ARI (sinusitis, pharyngitis, bronchitis, and URI-NOS) visits between 2009 and April 2018. Patients with complicating conditions were excluded. Antibiotic prescribing rates were calculated. A provider-directed VA-wide ARI campaign was initiated in October 2017. The Campaign was implemented locally by antibiotic stewards or regional personnel trained in academic detailing (AD). Campaign components: dashboards for tracking provider and facility prescribing metrics, printable feedback reports, and AD educational materials. Metrics include: ARI antibiotic prescribing rates, bronchitis/URI-NOS antibiotic prescribing rates, guideline-concordant antibiotic selection for sinusitis or pharyngitis, and proportion of ARI visits with a sinusitis diagnosis. A Logistic generalized estimating equation model assessed metrics over time pre/post intervention and chi-squared tests compared guideline concordant antibiotic proportions pre/post intervention.
Results: There were 1,580,612 and 137,421 ARI visits pre/post intervention, respectively. Antibiotic prescribing decreased from 2009, annual odds ratio (OR) 0.94 [95% CI 0.93, 0.96; p<0.001]. An additional effect was observed post-intervention [OR 0.88, (0.84, 0.88), p<0.001]. Bronchitis/URI-NOS prescribing rates decreased from 2009 [annual OR 0.94 (CI 0.93, 0.95), p<0.001]. Additional effect was observed post-intervention [OR 0.86, (0.81, 0.91), p<0.001]. Overall, the proportion of ARI visits diagnosed with sinusitis increased [annual OR 1.09 (1.08, 1.10), p<0.01], but the proportion of sinusitis diagnoses decreased [OR 0.72 (0.69, 0.75), p<0.001] post- intervention. Guideline-concordant antibiotic selection was 61.5% vs. 71.2% for sinusitis and 63.3% vs. 67.8% for pharyngitis pre/post intervention, respectively (both p<0.001).
Conclusion: Antibiotic prescribing rates for ARIs within the VA have steadily declined since 2010. Additional decline in antibiotic prescribing was associated with the launch of a national campaign to improve ARI management.
B. Pontefract, None
B. Jones, None
M. Jones, None
Y. Yao, None
M. Nevers, None
J. Ying, None
B. Haaland, None
C. Kay, None
M. Christopher, None
M. Samore, None
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