Impact of Education and Data Feedback Interventions on Outpatient Prescribing for Urinary Tract Infections

Background: Urinary tract infections (UTIs) are the most common outpatient indication for antibiotics and an excellent target for outpatient antimicrobial stewardship (AS) interventions. This study evaluated the impact of education and data feedback on outpatient UTI diagnosis and prescribing.

Methods: A clinic specific antibiogram, diagnosis and treatment guideline, and educational session were provided at one urgent care (UC) and one primary care (PC) clinic in Durham, NC in August and November of 2017. Educators reviewed the appropriate diagnosis, treatment, and duration of therapy for UTIs, including avoidance of treatment for asymptomatic bacteriuria and choice of first line agents with lower collateral damage. Adult encounters with a UTI diagnosis code from 11/2016 to 11/2017 and from 8/2016 to 8/2017 were included in the pre-intervention cohort for UC and PC, respectively. The post-intervention cohort included encounters following education intervention to 4/2018. Summary data of UTI diagnoses and guideline concordant prescriptions were fed back to clinics February 2018. The primary endpoint was proportion of first or second-line antibiotic choice for UTI according to clinic-specific guidelines. Pre- and post-intervention phase and trend changes were assessed by an interrupted time series approach.

Results: Data were collected on 2,660 and 1,016 UTI encounters at UC and PC, respectively. Guideline concordant prescribing increased at UC from 29% at baseline to 47% in the five months after the education and at PC from 54% at baseline to 62% in the eight months after the education (Figures 1 and 2). The mean number of UTI diagnoses per month decreased at UC from 142 at baseline to 102 and at PC from 32 at baseline to 25 after the education.

Conclusion: Clinicians increased guideline concordant prescribing and reduced diagnosis rates for UTIs. AS is effective at improving guideline directed diagnosis and management of UTIs in outpatient settings.

 

Figure 1. Time series analysis of UTI visits with prescriptions for guideline concordant antibiotics at UC

Figure 2. Time series analysis of UTI visits with prescriptions for guideline concordant antibiotics at PC