Mercy Health Saint Mary's Health System, Department of Pharmacy, Grand Rapids, Michigan.
Mercy Health Saint Mary's Health System, Department of Family Medicine, Residency Center Grand Rapids, Michigan.
Infect Control Hosp Epidemiol. 2021 Jun;42(6):715-721. doi: 10.1017/ice.2020.1275. Epub 2020 Nov 13.
To determine whether an ambulatory care pharmacist (AMCP)-led intervention improved outpatient antibiotic prescribing in a family medicine residency clinic (FMRC) for upper respiratory tract infections (URIs), urinary tract infections (UTIs), and skin and soft-tissue infections (SSTIs).
Retrospective, quasi-experimental study comparing guideline-concordant antibiotic prescribing before and after an antimicrobial stewardship program (ASP) intervention.
Family medicine residency clinic affiliated with a community teaching hospital.
Adult and pediatric patients prescribed antibiotics for URI, UTI, or SSTI between November 1, 2017, and April 31, 2018 (pre-ASP group), or October 1, 2018, and March 31, 2019 (ASP group), were eligible for inclusion.
The health-system ASP physician and pharmacist provided live education and pocket cards to FMRC staff with local guidelines as a quick reference. Audit with feedback was delivered every other week by the clinic's AMCP. Guideline-concordance was determined based on the institution's outpatient ASP guidelines.
Overall, 525 antibiotic prescriptions were audited (pre-ASP n = 90 and ASP n = 435). Total guideline-concordant antibiotic prescribing at baseline was 38.9% (URI, 53.3%; SSTI, 16.7%; UTI, 46.7%) and improved across all 3 infection types to 57.9% (URI, 61.2%; SSTI, 57.6%; UTI, 53.5%; P = .001). Significant improvements were seen in guideline-concordant antibiotic selection (68.9% vs 80.2%; P = .018), dose (76.7% vs 86.2%; P = .023), and duration of therapy (73.3% vs 86.2%; P = .02).
An AMCP-led outpatient ASP intervention significantly improved guideline-concordant antibiotic prescribing for common infections within a FMRC.
确定在家庭医学住院医师诊所（FMRC）中，由门诊护理药剂师（AMCP）领导的干预措施是否可以改善上呼吸道感染（URI）、尿路感染（UTI）和皮肤软组织感染（SSTI）的门诊抗生素处方。
回顾性、准实验研究，比较抗生素管理计划（ASP）干预前后符合指南的抗生素处方。
社区教学医院附属的家庭医学住院医师诊所。
2017 年 11 月 1 日至 2018 年 4 月 31 日（ASP 前组）或 2018 年 10 月 1 日至 2019 年 3 月 31 日（ASP 组）期间为 URI、UTI 或 SSTI 开抗生素处方的成年和儿科患者符合纳入标准。
医疗系统 ASP 医生和药剂师为 FMRC 工作人员提供现场教育和口袋卡片，同时提供当地指南作为快速参考。诊所的 AMCP 每隔一周提供一次审核和反馈。根据机构的门诊 ASP 指南确定符合指南的情况。
共审核了 525 份抗生素处方（ASP 前组 90 份，ASP 组 435 份）。基线时总共有 38.9%的抗生素处方符合指南（URI，53.3%；SSTI，16.7%；UTI，46.7%），所有 3 种感染类型的总符合率均有所提高，达到 57.9%（URI，61.2%；SSTI，57.6%；UTI，53.5%；P =.001）。在符合指南的抗生素选择（68.9% vs 80.2%；P =.018）、剂量（76.7% vs 86.2%；P =.023）和疗程（73.3% vs 86.2%；P =.02）方面均有显著改善。
由 AMCP 领导的门诊 ASP 干预措施显著改善了 FMRC 中常见感染的符合指南的抗生素处方。
