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

项目总结 门诊护理中急性呼吸道感染(ARTIS)的抗生素不当使用 是抗生素耐药性的主要驱动力，也是一个紧迫的公共卫生威胁。尽管几十年的研究和 尽管采取干预措施增加对ARTIS的循证护理，但取得的进展有限。远程医疗就诊 (THV)有可能通过解决以下因素来改善ARTI的管理和抗生素处方 影响不适当的护理，并通过实施一种在人群中优化结果的方法。 在新冠肺炎疫情高峰期，有必要转向通过THV进行护理，这创造了一种 增加了对远程医疗的接受度，这是解决这一问题的一个重要机会。我们建议 利用当前广泛使用远程医疗的创新前景来测试THV是否针对 ARTIS可以解决不适当护理的驱动因素，并改善管理。我们寻求进行一场严格的 使用混合方法开发和评估多点干预的实施研究 旨在改善Arti护理。我们将在门诊医疗保健环境中从三个不同的角度进行研究 医疗保健系统有来自不同种族和民族背景的患者，这些人以英语为对象 不是他们的主要语言，以及与健康的社会决定因素有关的差异。我们的研究将 首先使用ARTI遭遇(急性鼻窦炎、咽炎、 支气管炎和病毒性上呼吸道感染)在三个地点。预测工具将用于 确定通过THV进行ARTI管理的候选人，他们的风险较低，结果不佳。我们将把 将该工具纳入门诊护理工作流程，以优化对THV的适当分诊。其次，我们将使用之前的 我们团队的研究和其他公布的数据，以定义被确定为障碍和促进者的因素 给阿尔蒂斯开了不恰当的处方。利用这一背景，将开发材料，以促进适当的 管理和教育病人。这些材料将通过与供应商和 社区成员。患者材料将被翻译成反映患者群体的语言 提供服务，并对文化敏感。接下来，我们将在每个医院的诊所进行开放试验测试 三个参与的医疗保健系统，以改进流程和材料，并从双方获得反馈 患者和提供者的适应和改善。最后，我们将在六个方面实施该方法 地点--进行三个开放试点的地点和三个附属的社区实践。我们会 研究结果包括抗生素处方，是否需要随访和接触，以及患者和 提供者对THV、流程和医疗服务的满意度。根据我们对结果的评估， 包括可行性和可持续性在内，最终材料将被组织成工具包，供其他网站实施。

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.