Park Daniel E, Roberts Annie L S, Hamdy Rana F, Balthrop Sabrina, Dolan Patrick, Liu Cindy M
Department of Environmental and Occupational Health, George Washington University, Washington, DC, USA.
Children's National Hospital, Washington, DC, USA.
Infect Control Hosp Epidemiol. 2025 Jan 8;46(3):1-6. doi: 10.1017/ice.2024.213.
Urgent care centers (UCCs) have reported high rates of antibiotic prescribing for acute respiratory tract infections. Prior UCC studies have generally been limited to single networks. Broadly generalizable stewardship efforts targeting common diagnoses are needed. This study examines the effectiveness of an antibiotic stewardship intervention in reducing inappropriate prescribing for bronchitis and viral upper respiratory tract infections (URTIs) in UCCs.
A quality improvement study comparing inappropriate antibiotic prescribing rates in UCCs after the introduction of an antibiotic stewardship intervention.
Forty-nine UCCs in 27 different networks from 18 states, including 1 telemedicine site.
Urgent care clinicians from a national collaborative of UCCs, all members of the Urgent Care Association.
The intervention included signing a commitment statement and selecting from 5 different intervention options during 3 plan-do-study-act cycles. The primary outcome was the percentage of urgent care encounters for viral URTIs or bronchitis with inappropriate prescribing, stratified by clinician engagement and diagnosis. A 3-month baseline and 9-month intervention period were compared using a regression model using a generalized estimating equation.
Among 15,385 encounters, the intervention was associated with decreases in inappropriate antibiotic prescribing for bronchitis (48% relative decrease, aOR = 0.52; 95% CI, 0.33-0.83) and viral URTIs (33%, aOR = 0.67; 95% CI, 0.55-0.82) among actively engaged clinicians compared to baseline. The intervention did not result in significant changes for clinicians not actively engaged.
This intervention was associated with reductions in inappropriate prescribing among actively engaged clinicians. Implementing stewardship interventions in UCCs may reduce inappropriate antibiotic prescriptions for common diagnoses; however, active clinician engagement may be necessary.
急诊护理中心（UCCs）报告称，急性呼吸道感染的抗生素处方率很高。先前关于急诊护理中心的研究通常仅限于单个网络。需要针对常见诊断开展具有广泛推广性的管理工作。本研究考察了抗生素管理干预措施在降低急诊护理中心对支气管炎和病毒性上呼吸道感染（URTIs）不恰当处方方面的有效性。
一项质量改进研究，比较引入抗生素管理干预措施后急诊护理中心不恰当抗生素处方率。
来自18个州27个不同网络的49个急诊护理中心，包括1个远程医疗站点。
来自急诊护理中心全国协作组织的急诊护理临床医生，均为急诊护理协会成员。
干预措施包括签署一份承诺书，并在3个计划-执行-研究-行动周期中从5种不同的干预选项中进行选择。主要结局是因病毒性上呼吸道感染或支气管炎而接受不恰当处方的急诊护理就诊比例，按临床医生参与程度和诊断进行分层。使用广义估计方程的回归模型比较了3个月的基线期和9个月的干预期。
在15385次就诊中，与基线相比，该干预措施使积极参与的临床医生对支气管炎的不恰当抗生素处方减少（相对减少48%，调整后比值比[aOR]=0.52；95%置信区间[CI]，0.33 - 0.83），对病毒性上呼吸道感染的不恰当抗生素处方减少（33%，aOR = 0.67；95% CI，0.55 - 0.82）。对于未积极参与的临床医生，干预措施未导致显著变化。
该干预措施与积极参与的临床医生减少不恰当处方有关。在急诊护理中心实施管理干预措施可能会减少常见诊断的不恰当抗生素处方；然而，临床医生的积极参与可能是必要的。
