Improving antibiotic use for sinusitis and upper respiratory tract infections: A virtual-visit antibiotic stewardship initiative.
Improving antibiotic use for sinusitis and upper respiratory tract infections: A virtual-visit antibiotic stewardship initiative.
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改善鼻窦炎和上呼吸道感染的抗生素使用：虚拟访问抗生素管理计划。
DOI：
10.1017/ice.2022.19
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发表时间：
2022
影响因子：
4.5
通讯作者：
Petty,LindsayA
中科院分区：
文献类型：
--
作者：
Wasylyshyn,AnastasiaI;Kaye,KeithS;Chen,Julia;Haddad,Haley;Nagel,Jerod;Petrie,JoshuaG;Gandhi,TejalN;Petty,LindsayA
异步虚拟患者护理的应用越来越广泛；然而，与抗生素管理倡议相结合，实际提供符合指南的护理的有效性仍然不确定。我们开发了一种捆绑管理干预措施，以改善上呼吸道感染（URTIs）电子就诊中抗生素的使用。方法在这项前后对照研究中，纳入了2018年1月1日至2020年9月30日期间在密歇根医学中心完成“咳嗽”、“流感”或“鼻窦症状”电子就诊的成年患者。收集患者的人口统计、诊断和抗生素的详细信息。多方面的干预持续了6个月。采用分段线性回归来估计干预对尿路感染诊断（定义为没有抗生素处方）和鼻窦炎（定义为与指南一致的抗生素选择和持续时间）适当使用抗生素的影响。回归线拟合捆绑干预前（2019年1月）和捆绑干预后（2019年5月）的数据。结果共纳入5151次电子就诊。干预降低了流感、咳嗽或鼻窦症状的就诊次数，处方抗生素从43.2%降至28.9% （P < 0.001）。干预后抗生素处方指南一致性提高：一线阿莫西林-克拉维酸从37.9%上升到66.1% (P < 0.001)，二线多西环素从13.8%上升到22.7% (P < 0.001)；抗生素中位持续时间由10 d缩短至5 d （P < 0.001）。结论电子就诊的多方面管理包括EMR的改变以及审计和反馈，改善了尿路感染的抗生素使用指南。这种方法可以帮助管理工作在门诊护理设置关于远程医疗。
BackgroundAsynchronous virtual patient care is increasingly used; however, the effectiveness of virtually delivering guideline-concordant care in conjunction with antibiotic stewardship initiatives remains uncertain. We developed a bundled stewardship intervention to improve antibiotic use in E-visits for upper respiratory tract infections (URTIs).MethodsIn this before-and-after study, adult patients who completed E-visits for “cough,” “flu,” or “sinus symptoms” at Michigan Medicine between January 1, 2018, and September 30, 2020, were included. Patient demographics, diagnoses, and antibiotic details were collected. The multifaceted intervention occurred over 6 months. Segmented linear regression was performed to estimate the effect of the intervention on appropriate antibiotic use for URTI diagnoses (defined as no antibiotic prescribed) and sinusitis (defined as guideline-concordant antibiotic selection and duration). Regression lines were fit to data before the bundled intervention (January 2019) and after the bundled intervention (May 2019).ResultsIn total, 5,151 E-visits were included. The intervention decreased the number of visits for flu, cough, or sinus symptoms prescribed antibiotics from 43.2% to 28.9% (P < .001). Guideline concordance of antibiotic prescriptions improved following the intervention: first-line amoxicillin-clavulanate rose from 37.9% of prescriptions to 66.1% of prescriptions (P < .001), second-line doxycycline rose from 13.8% to 22.7% (P < .001); and median duration of antibiotics decreased from 10 days to 5 days (P < .001).ConclusionsA multifaceted stewardship bundle for E-visits involving both changes in the EMR and audit and feedback improved guideline-concordant antibiotic use for URTIs. This approach can aid stewardship efforts in the ambulatory care setting with regard to telemedicine.