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Courtney A, Cook G, Silio M. Evaluation of a Clinical Decision Support System and an Automated Electronic Health Record Alert on Outpatient Prescribing of Cefdinir. J Pediatric Infect Dis Soc 2024; 13:246-249. [PMID: 38520324 DOI: 10.1093/jpids/piae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 03/21/2024] [Indexed: 03/25/2024]
Abstract
Acute bacterial upper respiratory infections are common indications for antibiotics in pediatrics, and many prescriptions may be inappropriate. Novel approaches to outpatient antimicrobial stewardship interventions are needed. This quasi-experimental study of an order set and best practice advisory alert targeting cefdinir prescriptions demonstrated an 8.4% decrease in cefdinir prescribing (P ≤ .001).
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Affiliation(s)
- Ashleah Courtney
- Department of Pediatrics, Section of Pediatric Infectious Diseases, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Gregory Cook
- Department of Pharmacy, Children's Hospital New Orleans, New Orleans, Louisiana, USA
| | - Margarita Silio
- Department of Pediatrics, Section of Pediatric Infectious Diseases, Tulane University, New Orleans, Louisiana, USA
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Wushouer H, Du K, Chen S, Li H, Zhang W, Yang Y, Hu L, Zhou Y, Sun H, Zheng B, Guan X, Shi L. Evaluation of prescription review and feedback policy on rational antibiotic use in primary healthcare settings in Beijing, China: a qualitative study using the Theoretical Domains Framework and the behaviour change wheel. JAC Antimicrob Resist 2023; 5:dlad128. [PMID: 38046566 PMCID: PMC10691747 DOI: 10.1093/jacamr/dlad128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/14/2023] [Indexed: 12/05/2023] Open
Abstract
Objectives To decelerate antibiotic resistance driven by inappropriate antibiotic prescribing, a prescription review and feedback (PRF) policy is implemented in primary healthcare institutions (PHIs) in Beijing, China. However, evaluation of PRF implementation in PHIs is scarce. This study aims to systematically identify the barriers and facilitators of PRF policy implementation to provide evidence for antimicrobial stewardship. Methods We conducted key informant interviews with 40 stakeholders engaged in the implementation of PRF in Beijing, including physicians, pharmacists and administrators. Interviews were audio recorded and transcribed verbatim. We coded the interview transcripts and mapped informant views to domains of the Theoretical Domains Framework. We then used a behaviour change wheel to suggest possible behavioural interventions. Results Procedural knowledge (Knowledge) and skills (Skill) of PRF were possessed by stakeholders. They felt responsible to promote the appropriate use of antibiotics (Social/professional role and identity) and believed that PRF could help to change inappropriate provider behaviours (Behavioural regulation) in prescribing antibiotics (Beliefs about consequences) under increased intention on antibiotic use (Stages of change). Moreover, informants called for a more unified review standard to enhance PRF implementation (Goals). Frequently identified barriers to PRF included inadequate capacity (Skill), using punishment mechanism (Behaviour regulation), reaching consistently lower antibiotic prescription rates (Goals), lack of resources (Environmental context and resources) and perceived pressure coming from patients (Social influences). Conclusions Stakeholders believed that PRF implementation promoted the rational use of antibiotics at PHIs in Beijing. Still, PRF was hampered by inconsistencies in review process and resources needed for PRF implementation.
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Affiliation(s)
- Haishaerjiang Wushouer
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
- International Research Center for Medicinal Administration, Peking University, Beijing 100191, China
| | - Kexin Du
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Shicai Chen
- Department of Clinical Pharmacology, National Institute on Drug Dependence, Peking University, Beijing 100191, China
| | - Huangqianyu Li
- International Research Center for Medicinal Administration, Peking University, Beijing 100191, China
| | - Wanmeng Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yaoyao Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Lin Hu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yue Zhou
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
- Department of Pharmacy, Peking University People’s Hospital, Beijing 100044, China
| | - Hui Sun
- United Nations Children’s Fund, China Office, Beijing 100600, China
| | - Bo Zheng
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing 100034, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
- International Research Center for Medicinal Administration, Peking University, Beijing 100191, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
- International Research Center for Medicinal Administration, Peking University, Beijing 100191, China
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Fu M, Gong Z, Zhu Y, Li C, Zhou Y, Hu L, Li H, Wushouer H, Guan X, Shi L. Inappropriate antibiotic prescribing in primary healthcare facilities in China: a nationwide survey, 2017-2019. Clin Microbiol Infect 2022; 29:602-609. [PMID: 36436703 DOI: 10.1016/j.cmi.2022.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/03/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We aimed to generate comprehensive estimates of the appropriateness of outpatient antibiotic prescriptions at primary healthcare facilities (PHFs) in China. METHODS Between 2017 and 2019, we collected outpatient-visit prescriptions from 269 Chinese PHFs in 31 cities located in 6 provinces. Conditions that resulted in antibiotic use were classified into appropriate, potentially appropriate, and inappropriate using a well-established classification approach. We then assessed the magnitude, appropriateness, and costs of antibiotic prescribing, overall and by antibiotic classification group, diagnostic categories, and patient characteristics. RESULTS Of all eligible 209 662 antibiotic prescriptions, 147 758 (70.5%) were inappropriate, which accounted for 66.8% (558.0/835.3 thousand US dollars) of costs for antibiotics. Upper respiratory tract infections, acute bronchitis, and non-infectious gastroenteritis were responsible for 68.9% (101 744/147 758) of inappropriately antibiotic prescriptions. High inappropriate antibiotic prescribing rates were observed among children aged 0-5 years (78.5% (21 049/26 799)) and patients living in economically undeveloped areas (77.5% (38 430/49 587)). A total of 256 474 individual antibiotics were prescribed, of which 82.2% (210 885/256 474) were broad-spectrum antibiotics, with second-generation cephalosporins (15.1% (38 705/256 474)) and third-generation cephalosporins (14.6% (37 491/256 474)) being the most commonly prescribed subgroups. DISCUSSION Our findings highlight the excessive and inappropriate use of antibiotics in Chinese PHFs pending multidimensional efforts.
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Singh-Franco D, Hosein Mohammed S, Eckardt PA, Goldman J, Wolowich WR. Identification of Inappropriate Antibiotic Orders During Implementation of a Multidisciplinary Antimicrobial Stewardship Program Within the Primary Care Setting. J Patient Saf 2022; 18:e889-e894. [PMID: 35044997 DOI: 10.1097/pts.0000000000000968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to describe implementation of an outpatient antibiotic stewardship program at primary care practices in South Florida and the proportion of appropriate and inappropriate orders and reasons for inappropriateness during the intervention. METHODS An antibiotic stewardship committee at a large hospital system implemented aspects of The Core Elements of Outpatient Antibiotic Stewardship at outpatient facilities in 2018. Interventions included an education/awareness campaign directed at prescribers (audit and feedback, routine education at prescribers' meetings, availability of updated guidelines in a shared drive and antibiogram via intranet) and patients (posters, tear-off sheets on symptom relief for viral illness). Orders were evaluated using clinical documentation, current antibiogram, and Infectious Diseases Society of America guidelines. An appropriate order was defined as a correct antibiotic and dose/frequency and duration of therapy. An inappropriate antibiotic order was defined as not meeting 1 or more of the abovementioned conditions. Descriptive statistics assessed the data. RESULTS In this retrospective review of 2934 oral antibiotic orders from January 1 to December 31, 2018, 2565 (87.4%) were necessary while 369 (12.6%) were unnecessary. Of 2565 necessary orders, 1448 (56.5%) were appropriate while 1117 (43.5%) were inappropriate. Of 1117 inappropriate orders, 24.9% had all 3 conditions; 41.5% of inappropriate orders were solely due to wrong duration of therapy. CONCLUSIONS Although our institution demonstrated commitment to optimizing antibiotic prescribing by providing resources to clinicians and patients about evidence-based antibiotic prescribing, inappropriate antibiotic prescribing was persistent. The interventions used must continue to evolve and include point-of-care access to guidelines and clinical decision support tools.
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Affiliation(s)
- Devada Singh-Franco
- From the Pharmacy Practice, Nova Southeastern University, Health Professions Division, College of Pharmacy, Fort Lauderdale
| | | | | | | | - William R Wolowich
- From the Pharmacy Practice, Nova Southeastern University, Health Professions Division, College of Pharmacy, Fort Lauderdale
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Foreman BJ, Westerhof L, Benzer J, Eid K, Egwuatu NE, Dumkow LE. Impact of order sentence implementation on outpatient antibiotic prescribing for urinary tract infection and skin and soft tissue infection. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Brennan J. Foreman
- Department of Pharmacy Services Mercy Health Saint Mary's Grand Rapids Michigan USA
| | - Lindsey Westerhof
- Department of Pharmacy Services Mercy Health Saint Mary's Grand Rapids Michigan USA
| | - Jessica Benzer
- Department of Pharmacy Services Mercy Health Saint Mary's Grand Rapids Michigan USA
| | - Kristen Eid
- Department of Pharmacy Services Mercy Health Saint Mary's Grand Rapids Michigan USA
| | - Nnaemeka E. Egwuatu
- Division of Infectious Diseases Mercy Health Saint Mary's Grand Rapids Michigan USA
| | - Lisa E. Dumkow
- Department of Pharmacy Services Mercy Health Saint Mary's Grand Rapids Michigan USA
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Li LX, Szymczak JE, Keller SC. Antibiotic stewardship in direct-to-consumer telemedicine: translating interventions into the virtual realm. J Antimicrob Chemother 2021; 77:13-15. [PMID: 34618026 DOI: 10.1093/jac/dkab371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Direct-to-consumer (DTC) telemedicine is an increasingly popular modality for delivery of medical care via a virtual platform. As most DTC telemedicine visits focus on infection-related complaints, there is growing concern about the magnitude of antibiotic use associated with this setting. However, there is limited scholarship regarding adapting and implementing antibiotic stewardship principles in this setting as most efforts have been focused on hospitals with more recent work in long-term care facilities and primary care settings. We discuss utilizing the core elements for outpatient antibiotic stewardship as a framework for DTC antibiotic stewardship efforts moving forward.
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Affiliation(s)
- Lucy X Li
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julia E Szymczak
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sara C Keller
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Jensen KL, Rivera CG, Draper EW, Ausman SE, Anderson BJ, Dinnes LM, Christopherson DR, Prigge KA, Rajapakse NS, Vergidis P, Virk A, Stevens RW. From concept to reality: Building an ambulatory antimicrobial stewardship program. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Kelsey L. Jensen
- Department of Pharmacy Services Mayo Clinic Health System Austin Minnesota USA
| | | | - Evan W. Draper
- Department of Pharmacy Services Mayo Clinic Rochester Minnesota USA
| | - Sara E. Ausman
- Department of Pharmacy Services Mayo Clinic Health System Eau Claire Wisconsin USA
| | | | - Laura M. Dinnes
- Department of Pharmacy Services Mayo Clinic Rochester Minnesota USA
| | | | | | | | | | - Abinash Virk
- Division of Infectious Diseases Mayo Clinic Rochester Minnesota USA
| | - Ryan W. Stevens
- Department of Pharmacy Services Mayo Clinic Rochester Minnesota USA
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Outpatient prescribing pattern for acute bronchitis in primary healthcare settings in China. NPJ Prim Care Respir Med 2021; 31:24. [PMID: 33972552 PMCID: PMC8111021 DOI: 10.1038/s41533-021-00234-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/29/2021] [Indexed: 02/06/2023] Open
Abstract
Inappropriate prescribing for acute bronchitis in primary healthcare settings (PHSs) is commonly seen worldwide. Here we describe the prescribing patterns and antibiotic use for acute bronchitis in PHSs across China. We conduct a nationwide cross-sectional survey to collect outpatient prescriptions from PHSs in 2017. Patients diagnosed with acute bronchitis without other infections are eligible for this study. Generalized estimating equations are used for analysis. Overall, 10,678 prescriptions for acute bronchitis from 214 institutions are included. The antibiotic prescription rate is 44.5% for total prescriptions, and differs significantly by region and urban/rural status (p < 0.05). Among all single-antibiotic prescriptions, 91.5% are broad-spectrum. Two-thirds of the prescriptions contain medicines for symptom management. The overall guideline compliance rate of acute bronchitis treatment for adults is 31.0%. Prescribing antibiotics, especially broad-spectrum ones, for acute bronchitis is commonly observed in Chinese PHSs. Targeted interventions are urgently needed for Chinese primary clinicians, especially in western rural areas.
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