Outpatient antibiotic stewardship: Interventions and opportunities (original) (raw)
Related papers
A call to action for outpatient antibiotic stewardship
Journal of the American Pharmacists Association : JAPhA, 2017
To address the public health threat of antibiotic resistance, there has been an enhanced call for antibiotic stewardship programs throughout the health care continuum. While antibiotic stewardship programs have been well described in the inpatient setting, data on effectiveness and guidance on implementing outpatient programs is scarce. Establishing stewardship practices in the outpatient setting is necessary because more than 60% of human antibiotic use occurs in this setting. In this article, we highlight the importance and need for stewardship in the outpatient setting, discuss strategies for the development of stewardship teams, and discuss potential metrics that can be used to assess effectiveness of antibiotic stewardship interventions.
Sustaining outpatient antimicrobial stewardship: Do we need to think further outside the box?
Infection Control & Hospital Epidemiology, 2020
To the Editor-Antibiotic overuse is a persistent public health problem that has contributed to an alarming increase in the prevalence of antibiotic resistance. 1 In the United States, >70% of antibiotic courses are prescribed in ambulatory settings. 2 To encourage the appropriate use of antibiotics in outpatient practices, the Centers for Disease Control and Prevention (CDC) released the Core Elements of Outpatient Antibiotic Stewardship (hereafter Core Elements). 3 However, detailed evaluations of how practices implement and sustain the Core Elements are lacking. From January through June 2019, an antimicrobial stewardship quality improvement initiative was conducted by the American Academy of Pediatrics Chapter Quality Network (AAP-CQN), Colorado Department of Public Health and Environment, and the CDC. In this project, 8 outpatient pediatric practices in Colorado were enrolled: 3 practices that were part of larger systems and 5 independent practices. All practices but 1 were urban or suburban. The initiative utilized the Core Elements and Model for Improvement frameworks. 3 Practices implemented interventions to improve prescribing for pharyngitis and acute otitis media. The AAP-CQN provided webinars, learning sessions, monthly tracking and reporting, and Maintenance of Certification (MOC) credit. The ability of the practices to continue antibiotic stewardship following the conclusion of the initiative was assessed. Using surveys and telephone-based semistructured interviews with physician champions, we assessed the ability of practices to sustain the Core Elements of commitment, tracking and reporting, and education and expertise. Because the initial intervention focused on evaluation of the Core Element "action for policy and practice," our interviews targeted the other Core Elements. The project was determined exempt by the AAP Institutional Review Board. Most practices identified a leader for antibiotic stewardship (7 of 8) and intended to display commitment posters (5 of 7). 4 Most had access to antibiotic expertise (6 of 8) and planned to provide ongoing education regarding antibiotic use (6 of 8). Few practices had established systems for ongoing antibiotic stewardship-related duties (4 of 8), tracking (5 of 8), or reporting (3 of 7).
Clinical Infectious Diseases, 2016
Evidence-based guidelines for implementation and measurement of antibiotic stewardship interventions in inpatient populations including long-term care were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. The panel included clinicians and investigators representing internal medicine, emergency medicine, microbiology, critical care, surgery, epidemiology, pharmacy, and adult and pediatric infectious diseases specialties. These recommendations address the best approaches for antibiotic stewardship programs to influence the optimal use of antibiotics.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2016
Evidence-based guidelines for implementation and measurement of antibiotic stewardship interventions in inpatient populations including long-term care were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. The panel included clinicians and investigators representing internal medicine, emergency medicine, microbiology, critical care, surgery, epidemiology, pharmacy, and adult and pediatric infectious diseases specialties. These recommendations address the best approaches for antibiotic stewardship programs to influence the optimal use of antibiotics.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2014
The proven benefits of antibiotic stewardship programs (ASPs) for optimizing antibiotic use and minimizing adverse events, such as Clostridium difficile and antibiotic resistance, have prompted the Centers for Disease Control and Prevention (CDC) to recommend that all hospitals have an ASP. This article summarizes Core Elements of Hospital Antibiotic Stewardship Programs, a recently released CDC document focused on defining the infrastructure and practices of coordinated multidisciplinary programs to improve antibiotic use and patient care in US hospitals.
Creating a continuum of care through outpatient antimicrobial stewardship
Pharmacy Today, 2017
Creating a continuum of care through outpatient antimicrobial stewardship A recent CDC report underscored the need for a comprehensive approach to antibiotic prescribing and dispensing in the United States and endorsed the implementation of innovative antimicrobial stewardship programs (ASPs) 1-including ASPs in outpatient settings.
Infection and Drug Resistance
Background: There is a growing global interest in hospital-based antibiotic stewardship programs (ASPs). Centers for Disease Control and Prevention (CDC) recommends clinicians and facilities in outpatient department (OPD) to adhere to a set of stewardship activities called the Core Elements of Outpatient Antibiotic Stewardship (CEOAS). CEOAS includes 4 core elements for OPD facilities and clinicians each, ie, commitment, action, tracking and reporting, and education and expertise. Aim: The aim of this study was to evaluate the adherence of OPDs in tertiary care hospitals to CEOAS. Design and Setting: A cross-sectional study in the hospitals in Punjab, Pakistan. Methods: Study was reported as per STROBE guidelines. Data were collected from hospitals based on purposive sampling on the CEOAS framwork. On a summative scale, positive response to each core element worthed a score and higher the score better the adherence. Descriptive statistics was used for categorical variables while independent t-test computed group differences. Results: Fifty-three tertiary care hospitals (n=22 public, n=31 private) participated (response rate=86.9%). No hospital reported "perfect" adherence. Overall, facilities and clinicians in OPDs were moderately adherent. Subgroup analysis indicated that hospitals in public and private were poorly (4.9) and moderately (6.0) adherent to CEOAS respectively, however, private clinicians scored significantly higher in action, and tracking and reporting. Tracking and reporting of antibiotics and education of patients and clinicians emerged as top deficiency areas in facilities and clinicians respectively. Conclusion: Significant gaps exist in the adherence to CEOAS. The deficiency areas highlighted in the study should be given priority in future policy shift.