Iowa City Veterans' Administration Health Care System, Iowa City, Iowa.
University of Iowa, Carver College of Medicine, Iowa City, Iowa.
Infect Control Hosp Epidemiol. 2023 Dec;44(12):2028-2035. doi: 10.1017/ice.2023.81. Epub 2023 Jun 14.
We assessed the implementation of telehealth-supported stewardship activities in acute-care units and long-term care (LTC) units in Veterans' Administration medical centers (VAMCs).
Before-and-after, quasi-experimental implementation effectiveness study with a baseline period (2019-2020) and an intervention period (2021).
The study was conducted in 3 VAMCs without onsite infectious disease (ID) support.
The study included inpatient providers at participating sites who prescribe antibiotics.
During 2021, an ID physician met virtually 3 times per week with the stewardship pharmacist at each participating VAMC to review patients on antibiotics in acute-care units and LTC units. Real-time feedback on prescribing antibiotics was given to providers. Additional implementation strategies included stakeholder engagement, education, and quality monitoring.
The reach-effectiveness-adoption-implementation-maintenance (RE-AIM) framework was used for program evaluation. The primary outcome of effectiveness was antibiotic days of therapy (DOT) per 1,000 days present aggregated across all 3 sites. An interrupted time-series analysis was performed to compare this rate during the intervention and baseline periods. Electronic surveys, periodic reflections, and semistructured interviews were used to assess other RE-AIM outcomes.
The telehealth program reviewed 502 unique patients and made 681 recommendations to 24 providers; 77% of recommendations were accepted. After program initiation, antibiotic DOT immediately decreased in the LTC units (-30%; < .01) without a significant immediate change in the acute-care units (+16%; = .22); thereafter DOT remained stable in both settings. Providers generally appreciated feedback and collaborative discussions.
The implementation of our telehealth program was associated with reductions in antibiotic use in the LTC units but not in the smaller acute-care units. Overall, providers perceived the intervention as acceptable. Wider implementation of telehealth-supported stewardship activities may achieve reductions in antibiotic use.
我们评估了退伍军人事务部医疗中心（VA 医疗中心）的急性护理病房和长期护理（LTC）病房中远程医疗支持管理活动的实施情况。
前后对比、准实验实施效果研究，有基线期（2019-2020 年）和干预期（2021 年）。
该研究在 3 家没有现场传染病（ID）支持的 VA 医疗中心进行。
研究包括参与地点的住院医师，他们开抗生素处方。
在 2021 年，一名 ID 医生每周虚拟与每个参与 VA 医疗中心的药物管理药师三次会面，以审查急性护理病房和 LTC 病房中使用抗生素的患者。向提供者提供有关开抗生素处方的实时反馈。其他实施策略包括利益相关者参与、教育和质量监测。
使用可达性-有效性-采用-实施-维持（RE-AIM）框架进行项目评估。有效性的主要结果是所有 3 个地点的抗生素治疗日（DOT）每 1000 个治疗日的平均值。进行了中断时间序列分析，以比较干预期和基线期的这一比率。电子调查、定期反思和半结构化访谈用于评估其他 RE-AIM 结果。
远程医疗计划审查了 502 名独特患者，并向 24 名提供者提出了 681 项建议；77%的建议被接受。计划启动后，LTC 病房的抗生素 DOT 立即减少（-30%；<0.01），而急性护理病房的 DOT 没有明显的即时变化（+16%；=0.22）；此后，这两个病房的 DOT 都保持稳定。提供者普遍欣赏反馈和协作讨论。
我们的远程医疗计划的实施与 LTC 病房抗生素使用的减少有关，但与较小的急性护理病房无关。总的来说，提供者认为干预是可以接受的。更广泛地实施远程医疗支持的管理活动可能会减少抗生素的使用。
