159. Improving Antibiotic Use for Sinusitis and Upper Respiratory Tract Infections: A Virtual Visit Antibiotic Stewardship Initiative
159. Improving Antibiotic Use for Sinusitis and Upper Respiratory Tract Infections: A Virtual Visit Antibiotic Stewardship Initiative
复制标题
DOI：
10.1093/ofid/ofab466.159
复制
发表时间：
2021-12-04
影响因子：
4.2
通讯作者：
Petty LA
中科院分区：
文献类型：
--
作者：
Wasylyshyn A;Kaye KS;Chen J;Haddad H;Nagel J;Petrie JG;Gandhi TN;Petty LA
异步虚拟患者护理越来越受欢迎；然而，实际上提供符合指南的护理与抗生素管理举措的有效性仍然不确定。我们制定了捆绑式管理干预措施，旨在改善上呼吸道感染 (URTI) 电子就诊中抗生素的使用。在这项前后研究中，纳入了 2018 年 1 月 1 日至 2020 年 9 月 30 日期间在密歇根医学院完成“咳嗽”、“流感”或“鼻窦症状”电子就诊的成年患者。收集患者人口统计、诊断和抗生素详细信息。多方面的干预持续了 6 个月多的时间（图 1）。我们进行了分段线性回归，以评估干预措施对 URTI 诊断（定义为不开抗生素）和鼻窦炎（定义为符合指南的抗生素选择和持续时间）的适当抗生素使用水平和趋势的影响。回归线与医生拥护期之前（2019 年 3 月）和之后（2019 年 5 月）的数据进行拟合。在 5151 例电子就诊中，平均年龄为 46 岁，大多数患者为女性（71.3%，N=3674）。 3405/5151 次电子访问针对 URTI。在审计和反馈干预之前，URTI 的抗生素不当使用趋势稳定（图 2），干预后抗生素的不当使用减少了 12%（P 值 = 0.01）。干预后，不适当抗生素使用的趋势继续减少，每月减少 1.1%（P 值 = 0.02）（图 2a）。在专门针对鼻窦症状的 2493/5151 次电子就诊中，干预前符合指南的抗生素使用率较低（拦截 = 8%）（图 2b）。干预后，接受符合指南的抗生素治疗的患者估计增加了 47%（P 值 < 0.001）。实线代表网络研讨会的时间，虚线代表修订问卷推出和电子病历“推动”的时间，阴影区域是医师冠军干预的时间。针对鼻窦炎的符合指南的抗生素处方包括持续 5-7 天的阿莫西林/克拉维酸或多西环素 电子就诊的多方面管理包改进了 URTI 的符合指南的抗生素使用。经过一段时间的审核和反馈后，EMR 中实施的更改是最有益的。这种方法可以帮助门诊护理环境中的管理工作，特别是在远程医疗方面。 Tejal N. Gandhi，医学博士，密歇根州 Blue Cross Blue Shield（涉及个人：自己）：资助/研究支持 Lindsay A. Petty，医学博士，无需披露
Asynchronous virtual patient care is growing in popularity; however, the effectiveness of virtually delivering guideline-concordant care in conjunction with antibiotic stewardship initiatives remains uncertain. We developed a bundled stewardship intervention aimed at improving antibiotic use in E-visits for upper respiratory tract infections (URTIs). In this pre-post study, adult patients who completed an E-visit for “cough,” “flu,” or “sinus symptoms” at Michigan Medicine between 1/1/2018 and 9/30/2020 were included. Patient demographics, diagnoses, and antibiotic details were collected. The multi-faceted intervention occurred over 6 months (Figure 1). We performed segmented linear regression to estimate the effect of the intervention on the level and trend of appropriate antibiotic use for URTI diagnosis (defined as no antibiotic prescribed) and sinusitis (defined as guideline-concordant antibiotic selection and duration). Regression lines were fit to data before (March 2019) and after (May 2019) the physician championing period. Among 5151 E-visits, the mean age was 46 years old, and most patients were female (71.3%, N=3674). 3405/5151 E-visits were for URTI. Inappropriate antibiotic use for URTI was stable in trend prior to the audit and feedback intervention (Figure 2), followed by a 12% (P-value = 0.01) decrease in inappropriate antibiotic use post-intervention. The trend in inappropriate antibiotic use continued to decrease after the intervention by 1.1%/month (P-value = 0.02) (Figure 2a). Of 2493/5151 E-visits specifically for sinus symptoms, guideline-concordant antibiotic use was low (intercept = 8%) pre-intervention (Figure 2b). Post-intervention, there was an estimated 47% increase (P-value < 0.001) in patients receiving guideline-concordant antibiotics. Solid line represents time of the webinar, dashed line represents time of modified questionnaire roll out and electronic medical record “nudges”, and shaded area is time of physician champion intervention. Guideline-concordant antibiotic prescribing for sinusitis included amoxicillin/clavulanate or doxycycline prescribed for a duration of 5-7 days A multifaceted stewardship bundle for E-visits improved guideline-concordant antibiotic use for URTIs. Changes implemented in the EMR are most beneficial after a period of audit and feedback. This approach can aid stewardship efforts in the ambulatory care setting particularly with regards to telemedicine. Tejal N. Gandhi, MD, Blue Cross Blue Shield of Michigan (Individual(s) Involved: Self): Grant/Research Support Lindsay A. Petty, MD, Nothing to disclose