Pharmacy Service, Boise VA Medical Center, Boise, Idaho, USA.
Department of Pharmacy Practice, Pharmacy Practice, College of Pharmacy, Idaho State University, Meridian, Idaho, USA.
Clin Infect Dis. 2021 Sep 7;73(5):e1126-e1134. doi: 10.1093/cid/ciaa1831.
The Core Elements of Outpatient Antibiotic Stewardship provide a framework to improve antibiotic use. We report the impact of core elements implementation within Veterans Health Administration sites.
In this quasiexperimental controlled study, effects of an intervention targeting antibiotic prescription for uncomplicated acute respiratory tract infections (ARIs) were assessed. Outcomes included per-visit antibiotic prescribing, treatment appropriateness, ARI revisits, hospitalization, and ARI diagnostic changes over a 3-year pre-implementation period and 1-year post-implementation period. Logistic regression adjusted for covariates (odds ratio [OR], 95% confidence interval [CI]) and a difference-in-differences analysis compared outcomes between intervention and control sites.
From 2014-2019, there were 16 712 and 51 275 patient visits within 10 intervention and 40 control sites, respectively. Antibiotic prescribing rates pre- and post-implementation within intervention sites were 59.7% and 41.5%, compared to 73.5% and 67.2% within control sites, respectively (difference-in-differences, P < .001). Intervention site pre- and post-implementation OR to receive appropriate therapy increased (OR, 1.67; 95% CI, 1.31-2.14), which remained unchanged within control sites (OR,1.04; 95% CI, .91-1.19). ARI-related return visits post-implementation (-1.3% vs -2.0%; difference-in-differences P = .76) were not different, but all-cause hospitalization was lower within intervention sites (-0.5% vs -0.2%; difference-in-differences P = .02). The OR to diagnose non-specific ARI compared with non-ARI diagnoses increased post-implementation forintervention (OR, 1.27; 95% CI, 1.21 -1.34) but not control (OR, 0.97; 95% CI, .94-1.01) sites.
Implementation of the core elements was associated with reduced antibiotic prescribing for RIs and a reduction in hospitalizations. Diagnostic coding changes were observed.
门诊抗生素管理的核心要素为改善抗生素使用提供了一个框架。我们报告了退伍军人事务部（VA）各站点实施核心要素的影响。
在这项准实验性对照研究中，评估了一项针对治疗简单急性呼吸道感染（ARI）抗生素处方的干预措施的效果。研究结果包括每就诊次的抗生素处方、治疗的适宜性、ARI 复诊、住院和ARI 诊断在实施前 3 年和实施后 1 年的变化。采用逻辑回归调整协变量（比值比[OR]，95%置信区间[CI]），并通过干预和对照站点之间的差异分析比较结果。
2014 年至 2019 年，10 个干预站点和 40 个对照站点分别有 16712 次和 51275 次就诊。干预站点实施前后的抗生素处方率分别为 59.7%和 41.5%，而对照站点分别为 73.5%和 67.2%（差异，P<.001）。干预站点实施前后接受适宜治疗的 OR 增加（OR，1.67；95% CI，1.31-2.14），而对照站点则保持不变（OR，1.04；95% CI，.91-1.19）。实施后，ARI 相关复诊率（-1.3%与-2.0%；差异，P=.76）没有差异，但干预站点的全因住院率较低（-0.5%与-0.2%；差异，P=.02）。实施后，与非 ARI 诊断相比，诊断非特异性 ARI 的 OR 增加，干预站点（OR，1.27；95% CI，1.21-1.34），而对照站点（OR，0.97；95% CI，0.94-1.01）。
实施核心要素与减少 RI 抗生素处方和减少住院治疗有关。观察到诊断编码的变化。
