Fay Lauren N, Wolf Lauren M, Brandt Kasey L, DeYoung G Robert, Anderson Adam M, Egwuatu Nnaemeka E, Dumkow Lisa E
Pharmacy Department, Mercy Health Saint Mary's, Grand Rapids, MI.
Department of Emergency Medicine, Mercy Health Saint Mary's, Grand Rapids, MI.
Am J Health Syst Pharm. 2019 Jan 25;76(3):175-181. doi: 10.1093/ajhp/zxy023.
While many programs have demonstrated pharmacist-led antimicrobial stewardship successes in inpatient and emergency department (ED) settings, there is a paucity of literature exploring these initiatives in urgent care (UC) sites. This study aimed to determine the impact of implementing a pharmacist-led antimicrobial stewardship program (ASP) in the UC setting.
A retrospective quasi-experimental study was conducted evaluating UC patients with positive urine or wound cultures following discharge. A collaborative practice agreement was implemented in 2015 allowing for pharmacist-led UC culture follow-up via a stewardship-focused protocol. The primary outcome of this study was to compare guideline-concordant antibiotic prescribing between the pre-ASP and post-ASP groups. Secondary outcomes included comparing the number of patients who required follow-up, time to follow-up, UC or ED revisits within 72 hours, and hospital admission within 30 days between groups.
A total of 300 patients were included in the study (pre-ASP, n = 150; post-ASP, n = 150). Total guideline-concordant prescribing for all diagnoses was significantly improved in the post-ASP group (pre-ASP, 41.3% versus post-ASP 53.3%, p = 0.037). Additionally, guideline-concordant antibiotic selection improved in the post-ASP group (pre-ASP, 51% versus post-ASP, 68%, p = 0.01). Follow-up was required for 27 (18%) patients in the pre-ASP group compared with 16 (10.7%) in the post-ASP group (p = 0.07). Median time to follow-up call was longer in the post-ASP group (38 versus 71 hours, p < 0.001). There were no differences in UC and ED revisits within 72 hours (p = 1.0) or hospital admissions within 30 days (p = 0.723).
A pharmacist-led urgent care ASP was associated with significantly improved guideline-concordant antimicrobial prescribing.
虽然许多项目已证明在住院部和急诊科由药剂师主导的抗菌药物管理取得了成功，但在紧急护理（UC）场所探索这些举措的文献却很少。本研究旨在确定在UC环境中实施由药剂师主导的抗菌药物管理计划（ASP）的影响。
进行了一项回顾性准实验研究，评估出院后尿培养或伤口培养呈阳性的UC患者。2015年实施了一项合作实践协议，允许药剂师通过以管理为重点的方案对UC培养结果进行跟踪。本研究的主要结果是比较ASP实施前和实施后两组符合指南的抗生素处方情况。次要结果包括比较两组中需要随访的患者数量、随访时间、72小时内的UC或急诊科复诊情况以及30天内的住院情况。
共有300名患者纳入研究（ASP实施前，n = 150；ASP实施后，n = 150）。ASP实施后组中所有诊断的总体符合指南的处方情况有显著改善（ASP实施前为41.3%，ASP实施后为53.3%，p = 0.037）。此外，ASP实施后组中符合指南的抗生素选择情况有所改善（ASP实施前为5１%，ASP实施后为68%，p = 0.01）。ASP实施前组中有27名（18%）患者需要随访，而ASP实施后组中有16名（10.7%）患者需要随访（p = 0.07）。ASP实施后组的随访电话中位时间更长（38小时对71小时，p < 0.001）。72小时内的UC和急诊科复诊情况（p = 1.0）或30天内的住院情况（p = 0.723）没有差异。
由药剂师主导的紧急护理ASP与显著改善符合指南的抗菌药物处方有关。
