A national antibiotic stewardship program at ambulatory care centers was associated with reduced antibiotic prescribing during the pandemic, both overall and for acute respiratory infection cases, according to findings presented at the 2021 virtual IDWeek.
In this exclusive MedPage Today video, study author Sara Keller, MD, MPH, MSPH, assistant professor of medicine at Johns Hopkins University in Baltimore, describes the Agency for Healthcare Research and Quality (AHRQ) program design and where to find the associated resources online.
Following is a transcript of her remarks:
The AHRQ safety program for improving antibiotic use was designed to build antibiotic stewardship from the ground up, and really reframing antibiotic stewardship as an important approach to patient safety. There was an acute care cohort and a long-term care cohort, and the results that we’re talking about here are from the ambulatory care cohort that started in December 2019 and continued through November of 2020, which of course coincided with the start of the COVID-19 pandemic.
The program’s material focused on three areas — the need for practices to develop and improve antibiotic stewardship activities; approaches to communication about impact of prescribing along colleagues, patients, and families; and then best practices for treatment of common infectious syndromes seen in ambulatory care.
Our primary outcome was antibiotic prescribing for 100 visits compared with September 2019 at the beginning of the baseline period to November of 2020 at the end of the program.
We enrolled 467 practices initially, of which 389 remained in the program until completion. And 292 practices submitted enough data that we can analyze it. Of these practices we did see that the numbers of visits per practice declined significantly in the first few months of the pandemic, and then started to increase in May 2020, and have returned to baseline by the completion of the program.
Meanwhile for antibiotic prescriptions per 100 visits, there was an upward trend initially at the beginning of the pandemic in March 2020. And after this, there is a steady trend downwards in antibiotic prescribing for 100 visits, so that by the end of the program, their overall total antibiotic prescribing had declined by nine prescriptions per 100 visits between the beginning of the baseline period and the end of the program.
We also looked at acute respiratory infection visits. There was a rise in the baseline periods before the start of the program and then before the pandemic and then a significant drop in visits for acute respiratory infections, at the beginning of the pandemic. It rose a little bit after this, but remained below baseline.
However, antibiotic prescribing for 100 acute respiratory infection visits rose a little bit at the beginning of the pandemic, and then declined significantly so by the end of the program, there was a decrease of 15 prescriptions per 100 visits between the baseline period and the end of the program, which I thought was pretty significant.
The program and the associated materials are free and will be free when they become widely available. We do advise, though, that clinics provide resources so that stewardship leaders’ practices can do the work. And this might be protected time, reduced requirements for patient visits, or other resources to allow them to implement the program.
These free resources will be available by mid-2022 to help other practices improve prescribing, and are available at AHRQ.gov/HAI. And to be informed as to when this toolkit will be available, you can follow AHRQ on Twitter @ahrqnews or the AHRQ.gov list to be notified when this toolkit is live.
And while this website does not currently have information on the ambulatory toolkit, it does have toolkits for hospitals and long-term care facilities to implement antibiotic stewardship, so those are available currently.