A new study led by researchers from two health systems in Utah — Intermountain Health and University of Utah Health — finds that a targeted approach utilizing antibiotic management practices significantly reduces antibiotic overuse in emergency departments. Credit: Intermountain Health
Overuse of antibiotic prescriptions for patients with upper respiratory illnesses in urgent care clinics across the United States has been an ongoing challenge, but a new study led by researchers from two Utah health systems — Intermountain Health and University of Utah Health — finds that a targeted approach using antibiotic management practices significantly reduces the overuse of these drugs.
In this study, published today in JAMA network openedresearchers were able to reduce the prescribing rate at emergency care clinics by 15% – representing millions of doses of antibiotics – by leveraging antibiotic management initiatives designed specifically for these outpatient settings.
They say that when healthcare systems create and implement a tailored and targeted intervention specifically designed for urgent care facilities, they can be sure that patients are receiving more appropriate care for their illness.
Edward Stenehjem, MD, MSc, of Intermountain Health, and Adam Hersh, MD, Ph.D., of the University of Utah Health, both in Salt Lake City, led the study involving 38 Intermountain emergency centers across Utah.
“Antibiotic management can be done — and done right in urgent care settings,” says Dr. Stenehjem, principal investigator of the study for Intermountain Health. “That’s especially true for urgent care centers that are integrated into healthcare systems. These results show the role we can play in reducing prescription rates in these critical and unique healthcare environments, which is better for patients and our community at large.”
Emergency room facilities play a vital role in the American health care system. They are one of the fastest growing ambulatory care locations in the US, with patient visits increasing by 50% or more in recent years.
As helpful as they are in meeting major but not medical emergencies, urgent care has also lagged behind in terms of antibiotic management. Doctors in these settings are more likely to prescribe antibiotics even when they are unlikely to help a patient, which can lead to dangerous side effects and contribute to antibiotic resistance.
For the study, researchers at Intermountain created an urgent care-specific antimicrobial stewardship program for 38 different urgent care facilities in Utah, including 32 for patients of all ages — and six for children under the age of 18.
The intervention initiative included educating physicians and patients, new electronic health record tools, transparent benchmarking dashboards for clinics, and media targeting patients and clinicians to increase education and awareness.
Researchers tracked antibiotic prescriptions for respiratory illnesses, including bronchitis, sinusitis and pharyngitis. They chose respiratory disease because it’s the most common reason patients go to emergency care, and also because of the high rate of inappropriate antibiotic prescriptions given for them, said Dr. Stenehjem.
Researchers then compared the prescribing rate before and after the intervention and found a sharp drop.
From July 1, 2018 to June 30, 2019, before the intervention, antibiotics were prescribed for 48% of respiratory patient contacts in these urgent care settings. During the intervention period – from July 1, 2019 to June 30, 2020 – that percentage fell to 33%.
“The study provides an excellent model for what can be done to improve antibiotic prescribing in urgent care. We encourage other health systems and healthcare professionals to consider implementing these approaches in their urgent care practices. It will greatly contribute to optimizing patient safety and combating antibiotic resistance,” said Dr. Lauri Hicks, director of the CDC’s Office of Antibiotic Stewardship.
These lower rates have been maintained beyond the study period and remain below 30%, demonstrating that targeted intervention continues to work in these settings.
Dr. Stenehjem said these results show that when taking into account clinicians’ urgent care and patient needs — and addressing those specific needs in these busy, high-volume outpatient settings — antibiotic prescribing can become safe. lowered.
“These results highlight the importance of health systems, including urgent care clinics, as part of antibiotic management solutions,” said Dr. Stenehjem. “This isn’t one clinic. This isn’t two clinics. This is 38 clinics. When you think about the impact this has on one community, it’s a huge difference. It’s millions of doses of unnecessary antibiotics being avoided.”
More information:
Implementation of an Antibiotic Stewardship Initiative in a large emergency care network, JAMA network opened (2023).
Supplied by Intermountain Healthcare
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