Implementing Telemedicine to Improve Appropriate Antibiotic Prescribing for Acute Respiratory Tract Infections

实施远程医疗以改善急性呼吸道感染的适当抗生素处方

• 批准号: 10419727
• 负责人: TAMAR BARLAM
• 金额: $ 50万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10419727
• 关键词: Implementing; Telemedicine; Improve; Appropriate; Antibiotic

PROJECT SUMMARY Inappropriate antibiotic use for the management of acute respiratory tract infections (ARTIs) in ambulatory care is a major driver of antibiotic resistance and an urgent public health threat. Despite decades of research and interventions to increase evidence-based care for ARTIs, limited progress has been made. Telehealth visits (THVs) have the potential to improve ARTI management and antibiotic prescribing by addressing factors that influence inappropriate care and by implementing an approach that optimizes outcomes across populations. The shift to care via THVs necessitated during the peak of the COVID-19 pandemic has created a climate of increased acceptability for telemedicine and an important opportunity to address this question. We propose to leverage the current innovative landscape of expanded use of telehealth to test whether THV approaches for ARTIs can address drivers of inappropriate care and improve management. We seek to conduct a rigorous implementation study using a mixed methods approach to develop and evaluate a multisite intervention designed to improve ARTI care. We will conduct the study in ambulatory healthcare settings from three diverse healthcare systems with patients of a wide range of racial and ethnic backgrounds, those for whom English is not their primary language, and those with disparities related to social determinants of health. Our study will first construct a prediction tool using retrospective data for ARTI encounters (acute sinusitis, pharyngitis, bronchitis, and viral upper respiratory tract infections) at the three sites. The prediction tool will be used to identify candidates for ARTI management via THV who are at low risk for poor outcomes. We will incorporate the tool into the workflow of ambulatory care to optimize appropriate triage to THVs. Second, we will use prior research by our team and other published data to define factors identified as barriers and facilitators for inappropriate prescribing for ARTIs. Using that background, materials will be developed to facilitate appropriate management and to educate patients. Those materials will be created via co-production with providers and community members. Patient materials will be translated in languages reflective of the patient populations served and be culturally sensitive. We will next conduct open pilot testing at hospital-based clinics at each of the three participating healthcare systems to refine the process and materials and get feedback from both patients and providers for adaptation and improvement. Finally, we will implement the approach across six sites – the sites where the three open pilots were conducted and three affiliated community practices. We will study outcomes including antibiotic prescribing, need for follow-up visits and encounters, and patient and provider satisfaction with the THV, the process, and the medical care. Based on our assessment of outcomes, including feasibility and sustainability, final materials will be organized into a toolkit for other sites to implement.

项目摘要 在门诊护理中管理急性呼吸道感染（ARTIs）的抗生素使用不当 是抗生素耐药性的主要驱动因素，也是一个紧迫的公共卫生威胁。尽管经过几十年的研究和 尽管采取了一些干预措施，以增加对急性呼吸道感染者的循证护理，但取得的进展有限。远程保健访问 （THV）有可能通过解决以下因素来改善阿尔蒂管理和抗生素处方， 影响不适当的护理，并通过实施优化人群结果的方法。 在COVID-19大流行高峰期间，通过THV进行护理的转变是必要的， 提高远程医疗的可接受性，是解决这一问题的重要机会。我们建议 利用目前扩大使用远程医疗的创新格局，测试THV方法是否 ART可以解决不适当护理的驱动因素并改善管理。我们寻求进行严格的 采用混合方法进行实施研究，以制定和评价多点干预措施 旨在改善阿尔蒂护理。我们将在三个不同的门诊医疗机构进行研究 医疗保健系统与各种种族和民族背景的患者，那些英语是 非母语者，以及与健康的社会决定因素有关的差异者。我们的研究将 首先使用阿尔蒂遭遇（急性鼻窦炎，咽炎， 支气管炎和病毒性上呼吸道感染）。预测工具将用于 识别通过THV进行阿尔蒂管理的候选人，这些候选人的不良结局风险较低。我们将合并 将该工具纳入门诊护理工作流程，以优化THV的适当分诊。其次，我们将使用先验 我们团队的研究和其他已发表的数据，以确定被确定为障碍和促进因素的因素， 不适当的ARTs处方。利用这一背景，将编写材料， 管理和教育患者。这些材料将通过与供应商合作制作， 社区成员。患者材料将翻译成反映患者人群的语言 服务和文化敏感。下一步，我们将在下列各医院的诊所进行开放式试点测试： 三个参与的医疗保健系统，以完善过程和材料，并从双方获得反馈 患者和供应商的适应和改进。最后，我们将在六个方面实施该方法。 地点-开展三项开放式试点的地点和三项附属社区做法。我们将 研究结果包括抗生素处方、随访访视和就诊的需求以及患者和 提供者对THV、过程和医疗护理的满意度。根据我们对结果的评估， 包括可行性和可持续性，最后的材料将整理成一个工具包，供其他地点实施。