195. The Effect of Two Antibiotic Stewardship Interventions in a Telemedicine Practice
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions to Improve Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
  • IDWeek Poster_DOD_ARAC _18_Tong (3).pdf (5.3 MB)
  • Background: Direct-to-patient (DTP) telemedicine has been noted to have highly variable antibiotic prescribing practices. This study explores the effect of education and individualized provider prescribing feedback on antibiotic prescribing for acute upper respiratory tract infections (ARTIs) in a telemedicine practice.

    Methods: Doctor on Demand is a national DTP video visit medical practice that provides primary and mental health care to 1.6 million people. In April 2016, 62 physicians were randomized to two antibiotic stewardship intervention groups: Group A received education on best practices for antibiotic prescribing for sinusitis, pharyngitis and bronchitis, and Group B received education plus individualized and practice-wide feedback reports on antibiotic prescribing rates for two consecutive months (Apr-May) and again in October. In November, both groups received feedback reports. Antibiotic prescribing rates for all three conditions were tracked for both groups for the baseline period (January to March) and throughout the study duration.

    Results: During the baseline period, antibiotic prescribing rates for the three conditions combined was 71% for Group A and 69% for Group B. Antibiotic prescribing rates for both groups throughout the baseline and study periods are displayed in Figure 1. For Group A, prescribing rates declined from 71% (baseline) to 66% in May and for Group B declined from 69% (baseline) to 55%. During June-September, the monthly prescribing rate remained 66-69% for Group A and 56-57% for Group B. In November, following the additional individualized feedback report provided to both groups, the prescribing rate was 63% for Group A and 46% for Group B.

    Conclusion: Individualized prescribing feedback reports coupled with education to telemedicine providers was more effective than education alone in reducing unnecessary antibiotic prescriptions for ARTIs. These findings should be used to promote antibiotic stewardship across telemedicine and other care settings.

    Ian Tong, MD1, Kristin Dean, MD2, Daniel Park, MPH3, James Thompson, BS2, Lily Yan, MD4, Cindy Liu, MD, PhD, MPH5 and Rana Hamdy, MD, MPH, MSCE6, (1)Medicine, Stanford University Medical School, Stanford, CA, (2)Doctor on Demand, San Francisco, CA, (3)George Washington University School of Public Health, Washington, DC, (4)Medicine, Boston Medical Center, Boston, MA, (5)Environmental and Occupational Health, George Washington University School of Public Health, Washington, DC, (6)Infectious Diseases, Children's National Medical Center, Washington DC, DC


    I. Tong, Doctor On Demand: Shareholder , Salary .

    K. Dean, Doctor On Demand: Shareholder , Salary .

    D. Park, None

    J. Thompson, Doctor On Demand: Shareholder , Salary .

    L. Yan, None

    C. Liu, None

    R. Hamdy, None

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