Prigge, Kimberly

Abstract Background Outpatient antibiotic stewardship programs (ASP) are recommended by the CDC and Joint Commission. We analyzed the impact of annual, focused syndrome-specific ASP interventions on trends in long-duration antibiotic prescribing (LDAP). Methods This was a retrospective, observational, multicenter cohort study from November 2020 through June 2025. All ambulatory encounters generating systemic antibiotic prescriptions within the healthcare enterprise were screened. Hospitalizations, emergency department visits, and infectious diseases encounters were excluded. Encounters generating ≥1 systemic antibiotic with >7 days duration were categorized as long-duration. Targeted departments (primary and urgent care) received direct intervention (eg, education, peer-comparison reporting, data tracking). LDAP was modeled over time by month and compared by diagnosis group (ASP-priority diagnoses vs nonpriority) and provider specialty department (ASP-targeted vs nontargeted) using linear regression models. Results Of 642 579 encounters included, 42.2% were long duration. LDAP in ASP-targeted departments dropped from 46.8% to 34.8% (difference −12 percentage points [pp]), whereas nontargeted departments dropped from 45.5% to 39.1% (difference −6.4 pp). The estimated annual LDAP decrease was 3.4 pp in targeted versus 2.4 pp in nontargeted departments (difference 1.0 pp, P = .009). Within targeted departments, significant LDAP decreases were seen both in priority and nonpriority diagnoses, whereas nontargeted departments showed no change in LDAP in priority diagnoses. In a sensitivity analysis of nonpriority diagnoses, ASP-targeted departments had a larger estimated annual decrease in LDAP versus nontargeted (difference 1.4 pp, P < .001). Conclusions Annual syndrome-specific ASP interventions correlated with improvements in LDAP, including outside of priority syndromes in targeted departments. LDAP is a viable metric for evaluating ambulatory ASPs.

Abstract Background The aim of this study was to evaluate the frequency of unnecessary antibiotic prescribing for Tier 3 upper respiratory infection (URI) syndromes across the Mayo Clinic Enterprise before and after a multifaceted antimicrobial stewardship intervention, and to determine ongoing factors associated with antibiotic prescribing and repeat respiratory healthcare contact in the postintervention period. Methods This was a quasi-experimental, pre/post, retrospective cohort study from 1 January 2019 through 31 December 2022, with 12-month washout during implementation from 1 July 2020 through 30 June 2021. All outpatient encounters, adult and pediatric, from primary care, urgent care, and emergency medicine specialties with a Tier 3 URI diagnosis were included. The intervention was a multifaceted outpatient antibiotic stewardship bundle. The primary outcome was the rate of antibiotic prescribing in Tier 3 encounters. Secondary outcomes included 14-day repeat healthcare contact for respiratory indications and factors associated with persistent unnecessary prescribing. Results A total of 165 658 Tier 3 encounters, 96 125 in the preintervention and 69 533 in the postintervention period, were included. Following intervention, the prescribing rate for Tier 3 encounters decreased from 21.7% to 11.2% (P < .001). Repeat 14-day respiratory healthcare contact in the no antibiotic group was lower postintervention (9.9.% vs 9.4%; P = .004). Multivariable models indicated that increasing patient age, Charlson comorbidity index, and primary diagnosis selected were the most important factors associated with persistent unnecessary antibiotic prescribing. Conclusions Outpatient antibiotic stewardship initiatives can reduce unnecessary antibiotic prescribing for Tier 3 URIs without increasing repeat respiratory healthcare contact. Advancing age and number of comorbidities remain risk factors for persistent unnecessary antibiotic prescribing.

Abstract Background URIs are the most common indication for outpatient antibiotic prescribing. Given high rates of unnecessary prescribing, these indications have been identified as a high-priority target for outpatient antimicrobial stewardship programs (ASP). Our primary objective was to evaluate the impact of a system-wide, multifaceted, outpatient ASP intervention bundle on unnecessary antibiotic prescribing for URI. Methods This quasi-experimental study was conducted from 2019 to 2021. ICD-10 codes for URIs were grouped into 3 tiers (i.e., tier I = antibiotics always indicated, tier II = sometimes, tier III = never). Encounters from 5 care specialties (i.e., family medicine, community internal medicine, express care, pediatrics, and emergency department) with a tier III URI primary ICD-10 code but without a secondary tier I or tier II code were included. COVID-19 ICD-10 codes were excluded. Interventions included construction of a prescribing data model, dissemination of clinician prescribing data and education, promotion of symptom management strategies, a patient-facing commitment poster, and a pre-populated URI order panel. Tools were designed at a system level and implemented by regional champions beginning in the 3rd quarter of 2020. The primary outcome was the rate of antibiotic prescribing, and the secondary outcome and counterbalance measure was the rate of repeat URI-related healthcare contact within 14 days. Outcomes were analyzed with chi-square with an α level of 0.05. Results A total of 147403 encounters were included. The overall antibiotic prescribing rate decreased from 24.1% to 12.3% between 2019 and 2021 (p< 0.01). Significant reductions in tier III antibiotic prescribing were demonstrated for each region, care specialty, and syndrome evaluated (Table 1). A reduction in repeat healthcare contact was seen across the total cohort (9.5% in 2019 vs. 8.3% in 2021, p< 0.01); decreases in repeat contact rates were observed in those not initially receiving an antibiotic (10.3% vs. 8.6%, p< 0.01), but not in those who initially received an antibiotic (6.8% vs. 6.8%, p = 0.94). Tier III URI encounter level antimicrobial prescribing rates by region, care specialty, and syndrome Conclusion A multifaceted, outpatient ASP intervention bundle decreased rates of unnecessary antimicrobial prescribing without increasing rates of 14-day repeat URI-related healthcare contact. Disclosures Paschalis Vergidis, MD, AbbVie: DSMB|Cidara: Grant/Research Support|Scynexis: Grant/Research Support Evan Draper, PharmD, Gilead Foundation: Grant/Research Support Sara Ausman, PharmD, Gilead: Honoraria Christina G. Rivera, PharmD, Gilead: Grant/Research Support|Gilead: Honoraria|Insmed: Honoraria.

Objective: To determine whether there are differences in asthma management provided in the retail clinic setting versus in the primary care setting, and whether it would increase the number of well controlled asthmatics as determined by ACT score of 20 or greater, and less than or equal to 1 ED or hospital visit due to asthma, within 6 months. Methods: All asthma patients with an asthma control test (ACT) of 19 or less, received a new or updated asthma action plan (AAP) at the visit. If the patient presented to the retail clinic during an asthma exacerbation or with any asthma symptoms, they were not given an ACT and received usual care. Asthma quality data was retrospectively collected for primary care patients seen in the 6-months prior to as well as up to 6 months after the patient’s enrollment visit. Results: There was no significant difference in the number of admissions between locations in either the pre-implementation period or the post-implementation period for either the pediatric or adult cohort. There was a significant improvement in the percentage of pediatric and adult patients with at least 1 ACT in the post-implementation compared to pre-implementation for both retail clinic and primary care sites. The percentage of pediatric and adult patients with at least 1 AAP increased in the post-implementation compared to pre-implementation for both retail clinic and primary care sites. Conclusion: Retail clinics may be able to provide asthma management with similar outcomes to primary care settings.

AbstractHuman antimicrobial consumption largely occurs in the ambulatory setting, with inappropriate or unnecessary antimicrobial prescribing well documented in the literature. In 2020, The Joint Commission implemented a regulatory standard requiring the development and implementation of antimicrobial stewardship programs (ASP) in those institutions surveyed under the ambulatory accreditation standard. While experience with inpatient antimicrobial stewardship has continued to increase, ambulatory ASPs are programmatically distinct and can present unique challenges with regards to operationalizing regulatory components. Herein, we lay a framework for addressing the task of developing an ambulatory ASP for a large health system by reviewing the regulatory requirements, examining relevant recent publications, and describing our institutional experience.