208. Trends in Antibiotic Prescribing for Acute Respiratory Tract Infections and Implementation of a Provider-Directed Intervention Within the Veterans Affairs Healthcare System (VA)
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions to Improve Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
  • ARIl_ID_Week_2018_Poster#208.pdf (443.3 kB)
  • 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.



    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, Barbara Jones, MD, University of Utah, Salt Lake City, UT, Makoto Jones, MD, MS, Internal Medicine, VA Salt Lake City Health Care System, Salt Lake City, UT, Yiwen Yao, MStat, VA Salt Lake City Healthcare System, Salt Lake City, UT, 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, Chad Kay, Pharm. D, San Diego VAMC, San Diego, CA, Melissa Christopher, PharmD, VA PBM Academic Detailing Service, VA, San Diego, CA 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

    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

    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.