179. A Passive, Prescriber-Directed, Electronic Alert Plus Prescriber Education Decreased Antibiotic Prescribing for Ambulatory Adults with Acute, Uncomplicated Bronchitis in a Large Integrated Health System
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions Leveraging the Electronic Health Record
Thursday, October 4, 2018
Room: S Poster Hall
  • IDWeek Poster Bronchitis FINAL.pdf (260.6 kB)
  • Background: Antibiotics (ABX) are often prescribed for acute bronchitis (AB).  Reducing inappropriate ambulatory ABX use is critical to combat ABX resistance and reduce ABX-related adverse events.  We sought to determine the impact of a passive, prescriber-directed, electronic best practice alert (BPA) coupled with prescriber education on ABX prescribing for ambulatory adults with AB.

    Methods: A retrospective, quasi-experimental study of adults with a primary diagnosis of AB discharged from any emergency department (ED), urgent care (UC) or ambulatory clinic (AC) within an integrated health system was performed.  AB diagnosis codes triggered the BPA.  An online continuing education course was created for prescribers.  The pre-intervention period (PRE) was 1/1/16 – 11/30/16 for UC and ED sites and 1/1/16 – 9/28/17 for AC sites.  The post-intervention period (POST) was 12/1/16 – 3/31/18 for UC and ED sites and 9/29/17 – 3/31/18 for AC sites.  The primary outcome was an ABX prescription targeting the upper respiratory tract.  Patient- and prescriber-level data were collected.  Forward stepwise multivariable (MV) logistic regression was used to determine predictors of ABX prescribing, with a p-value < 0.05 for model entry.

    Results: A total of 136,818 unique ambulatory adults had a primary diagnosis of AB.  An 8.3% reduction in ABX prescribing for AB was observed (49,246 out of 79,299 patients [62.1%] PRE v. 30,918 out of 57,519 patients [53.8%] POST; p<0.0001), corresponding  to 3,652 less ABX prescriptions.  ABX prescribing rates by setting are shown in Table 1 and Figure 1. In MV analysis, POST patients were less likely to receive ABX (aOR 0.60, 95% CI 0.58 – 0.62); however, patients who smoked or presented for a walk-in visit were more likely to receive ABX (aOR 1.148, 95% CI 1.11 – 1.19 and aOR 1.45, 95% CI 1.40 – 1.50, respectively).

    Conclusion: A passive, prescriber-directed, electronic BPA combined with education was associated with a statistically significant reduction in ABX prescribing for ambulatory adults with AB, particularly in the ED.

    Table 1.  ABX Prescribing Rates by Setting



    ABX Prescribed, n (%)



    1585 (54.4)


    1256 (34.4)



    19045 (66.8)


    23749 (56.4)



    28616 (59.8)


    5913 (50.2)

    Figure 1. ABX Prescribing Rates over Time for A. ED, B. UC, and C. AC

    Courtney Horvat, PharmD1, Thomas J. Dilworth, PharmD1, Lynne Fehrenbacher, PharmD2, Regina Manansala, MPH3 and Charles F. Brummitt, MD4, (1)Department of Pharmacy Services, Aurora Health Care, Milwaukee, WI, (2)Department of Pharmacy Practice, Concordia University School of Pharmacy, Mequon, WI, (3)University of Wisconsin – Milwaukee, Milwaukee, WI, (4)Infectious Diseases Section, Aurora Health Care, Milwaukee, WI


    C. Horvat, None

    T. J. Dilworth, None

    L. Fehrenbacher, None

    R. Manansala, None

    C. F. Brummitt, None

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