Variability in Antimicrobial Prescribing Across Five Ambulatory Settings Within a Large Integrated Health System.

Autor:	Taylor AD; Department of Pharmacy, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA., Rivard KR; Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA., Pallotta AM; Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA., Daniels HL; Center for Pediatric Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA., Fraser TG; Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA., Fertel BS; Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.; Quality and Patient Safety New York Presbyterian Hospital, New York, NY, USA., Lam S; Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA., Wu JY; Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA.
Jazyk:	angličtina
Zdroj:	Journal of pharmacy practice [J Pharm Pract] 2024 Aug 04, pp. 8971900241271956. Date of Electronic Publication: 2024 Aug 04.
DOI:	10.1177/08971900241271956
Abstrakt:	Background: Lack of access to timely, detailed antibiotic use data has limited ambulatory antibiotic stewardship efforts. Antibiotic utilization is tracked across ambulatory care sites and emergency departments (ED) within a large integrated health system. Methods: This is a retrospective cohort analysis from June 1, 2019 to May 31, 2020 comparing antibiotic prescribing for all patients with ICD-10 diagnosis codes for cystitis, otitis media, pharyngitis, sinusitis, and upper respiratory tract infections (URTIs) among five ambulatory care departments across northeast Ohio and southeast Florida locations: ED, Urgent Care (UC), On-Demand Telehealth (TEL), Pediatrics (PED), and Primary Care (PC). Results: A total of 261,947 encounters were included (ED:56,766, UC:92,749, TEL:8,783, PED:29,151, PC:74,498) for the treatment of cystitis (30,932), otitis media (22,094), pharyngitis (59,964), sinusitis (53,693), or URTI (95,264). The population was 63% female with a median age of 34.2 years [12.8-56.3]. A total of 17% of patients had documented penicillin allergies and 18% of patients with pharyngitis received Group A Streptococcus (GAS) testing. Antibiotics were prescribed in 44% of encounters (ED:21,746 [38%], UC:45,652 [49%], TEL:4,622 [53%], PED:10,909 [37%], PC:33,547 [45%]; P < 0.001). Guideline concordant antibiotics were prescribed in 65% of encounters (ED:14,338 [66%], UC:31,532 [69%], TEL:3,869 [84%], PED:8,212 [75%], PC:17,263 [51%]; P < 0.001). Conclusions: Observed rates of antibiotic and guideline concordant antibiotic prescribing were similar to national published rates of antibiotic prescribing in the ambulatory setting. The variability in antibiotic prescribing demonstrates opportunities for targeted outpatient stewardship efforts. Timely antibiotic tracking tools can facilitate ambulatory antimicrobial stewardship activities. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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