Introducing antimicrobial stewardship to the outpatient clinics of a suburban academic health system.
Introducing antimicrobial stewardship to the outpatient clinics of a suburban academic health system.
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DOI：
10.1017/ash.2021.228
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Albarillo, Fritzie
中科院分区：
文献类型：
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作者：
Nielsen, Travis B;Santarossa, Maressa;Probst, Beatrice;Labuszewski, Laurie;Lopez, Jenna;Barsanti-Sekhar, Mary;Albarillo, Fritzie
建立门诊抗菌药物管理计划。要求抗菌药物处方者完成一项关于抗菌药物管理的调查。我们亦监察彼等遵守适当处方常规的情况，并于每月质量改善报告中分享。这项研究是在洛约拉大学卫生系统进行的，这是一个大都市郊区环境中的学术教学卫生保健系统。19个初级保健和3个即时和紧急护理诊所的抗菌药物处方者。自愿调查是使用SurveyMonkey开发的，并通过电子邮件分发。数据是匿名收集的。从电子健康记录中提取适当处方实践的依从率，并通过3个指标进行评估：（1）成人急性支气管炎患者避免使用抗生素，（2）咽炎检测患者和（3）上呼吸道感染儿童接受适当抗生素治疗。处方医生非常了解什么是适当的处方;验证的依从率与自我报告的比率高度一致。几乎所有处方医生都担心耐药性，但只有不到一半的人认为他们的办公室开了过量的抗生素。在受访者中，74%的人报告说，来自患者的巨大压力使他们不适当地开抗菌药物。即时和紧急护理处方者的依从率高于初级护理处方者，后者对月度报告和在线教育资源的反应良好。来自患者的强烈压力，在没有指示的情况下开抗菌药物，导致过度开药，患者满意度评分的重要性加剧了这种影响。依从性报告改善了初级保健环境中适当抗生素处方的数量。
To establish an antimicrobial stewardship program in the outpatient setting. Prescribers of antimicrobials were asked to complete a survey regarding antimicrobial stewardship. We also monitored their compliance with appropriate prescribing practices, which were shared in monthly quality improvement reports. The study was performed at Loyola University Health System, an academic teaching healthcare system in a metropolitan suburban environment. Prescribers of antimicrobials across 19 primary care and 3 immediate- and urgent-care clinics. The voluntary survey was developed using SurveyMonkeyand was distributed via e-mail. Data were collected anonymously. Rates of compliance with appropriate prescribing practices were abstracted from electronic health records and assessed by 3 metrics: (1) avoidance of antibiotics in adult acute bronchitis and appropriate antibiotic treatment in (2) patients tested for pharyngitis and (3) children with upper respiratory tract infections. Prescribers were highly knowledgeable about what constitutes appropriate prescribing; verified compliance rates were highly concordant with self-reported rates. Nearly all prescribers were concerned about resistance, but fewer than half believed antibiotics were overprescribed in their office. Among respondents, 74% reported intense pressure from patients to prescribe antimicrobials inappropriately. Immediate- and urgent-care prescribers had higher rates of compliance than primary-care prescribers, and the latter group responded well to monthly reports and online educational resources. Intense pressure from patients to prescribe antimicrobials when they are not indicated leads to overprescribing, an effect compounded by the importance of patient satisfaction scores. Compliance reporting improved the number of appropriate antibiotics prescribed in the primary care setting.