Factors Associated with Acceptance of Telehealth-based Antimicrobial Stewardship Program Recommendations in a Community Hospital Health System

Health System and Tele-Antimicrobial Stewardship: The Role of Building Networks

Tele-antimicrobial stewardship programs (tele-ASPs) use technology and remote access to resources and clinical expertise to expand antimicrobial services within and outside of health systems. Models of tele-ASPs are workforce multiplying and workforce extending, depending on how they are structured. Building rapport and strong interpersonal networks are essential for successful ASPs. The available evidence suggests that an optimal model for tele-ASP includes hands-on involvement from remote infectious disease (ID) expertise with implementation by local pharmacists. However, this model remains limited by the available time and cost of ID-trained specialists.

Demographic and Geographic Inequities in Antimicrobial Use and Prescribing

Little is known about how social determinants of health may impact antimicrobial prescribing among racial and ethnic minority populations, different age groups and genders, and across geographic regions. The factors that influence antimicrobial prescribing are complex, but evidence suggests that demographic and socioeconomic factors do influence prescribing patterns. This review describes the inequities observed in antimicrobial use and prescribing that have been heretofore published, with a focus on differences observed by race and ethnicity, age, gender, and geographic region of the United States.

CLinician and patient characteristics effect on Antimicrobial Stewardship Interventions (CLASI) study

OBJECTIVE

To determine whether the gender of clinicians making antimicrobial stewardship recommendations has an impact on intervention acceptance rate.

DESIGN

A retrospective, multivariable analysis of antimicrobial stewardship prospective audit and feedback outcomes.

SETTING

A multisite healthcare system including Mayo Clinic Rochester (MN), Mayo Clinic Arizona, Mayo Clinic Florida and 17 health-system hospital sites, where prospective audit and feedback is performed and documented within an electronic tool embedded in the medical record.

PARTICIPANTS

The study included 143 Mayo Clinic clinicians (84 cisfemales and 59 cismales).

METHODS

Outcomes were analyzed from July 1, 2017, to June 30, 2022, for intervention rates, communication methods, and intervention acceptance by clinician gender, profession, patient age, and intensive care unit (ICU) status of patient.

RESULTS

Of 81,927 rules, 71,729 rules met study inclusion. There were 18,175 (25%) rules associated with an intervention. Most of the rules were reviewed by pharmacists (86.2%) and stewardship staff (85.5%). Of 10,363 interventions with an outcome documented, 8,829 (85.2%) were accepted and 1,534 (14.8%) were rejected. Female clinicians had 6,782 (86.5%) of 7,843 interventions accepted, and male clinicians had 2,047 (81.2%) of 2,520 interventions accepted (P = .19). Female patients had more interventions than male patients (female vs male: 25.9% vs 24.9%; OR, 1.04; 95% CI, 1.02-1.08; P = .001). Patients in the ICU had a significantly lower intervention acceptance rate (ICU vs non-ICU: 78.2% vs 86.7%; OR, 0.56; 95% CI, 0.45-0.7; P < .001).

CONCLUSIONS

Female and male clinicians were equally effective at prospective audit and feedback in a multisite antimicrobial stewardship program. Patients in the ICU were less likely to have stewardship interventions accepted.