Reviewed by Cindy Noyes, MD, University of Vermont Medical Center
The majority of antibiotic prescriptions in the US result from outpatient encounters, and with urgent care (UC) volumes increasing, there is an opportunity for stewardship in this setting. A quality improvement project undertaken in a large UC network, including both adult and pediatric providers, aimed to reduce antibiotic prescriptions for respiratory indications. Interventions included 1) education for patients and clinicians, 2) electronic medical record tools, 3) a clinician benchmarking dashboard and 4) a media campaign. Concurrently, though not a part of the intervention, administrative leaders instituted antibiotic stewardship as a quality measure linked to compensation for providers. Compared to baseline (July 2018-June 2019), there was a reduction from 47.8% to 33% in antibiotic prescriptions for respiratory conditions during the intervention period (July 2019-June 2020) and this was sustained during the sustainability period (July 2020-June 2021). Secondary aims evaluated antibiotic prescription by indication with reduced prescriptions for indications such as bronchitis, which do not warrant antibiotic therapy and adherence to preferred first line agents, both of which improved. Additionally, ED visits and/or hospitalizations of those patients were not increased. Thus, stewardship can be successful in urgent cares, although the impact of stewardship intervention and quality measures linked to provider compensation could not be evaluated independently.
Reference:
Stenehjem E, et al. Implementation of an antibiotic stewardship initiative in a large urgent care network. JAMA Network Open. 2023; 6(5): e2313011. Doi:10.011001/jamanetworkopen.2023.13011