A Tale of 2 Settings: How Outpatient Clinics Differ From Institutions in Delivering Stewardship
Kevin Nguyen, PharmD, offers some insights on some of the challenges in the outpatient setting with regards to stewardship, and novel strategies being utilized.
Antimicrobial stewardship can be deployed differently depending on the setting. Whereas, in bigger hospitals and medical systems they are equipped with staff and equipment and resources for antimicrobial stewardship initiatives, outpatient clinics may not due to lacking these factors.
In 2013, approximately 269 million antibiotic prescriptions were dispensed from outpatient pharmacies in the United States. Additionally, approximately 20% of pediatric visits and 10% of adult visits in outpatient settings result in an antibiotic prescription.1
At the World AMR Congress in Philadelphia last week, Kevin Nguyen, PharmD, BCIDP, clinical specialist, infectious disease, associate director of Antimicrobial Stewardship at St. Christopher's Hospital for Children in Philadelphia, made a presentation, From Bedside to Clinic: Navigating the Landscape of Antimicrobial Stewardship Challenges. And in it, he discussed some of the ongoing challenges including that outpatient clinics are not on a level playing field with hospitals for resources.
“Roughly 80, maybe 90% of antibiotics are used in the outpatient setting, but the vast majority of our resources are inpatient,” Nguyen said. “So I think a shift towards more resources and funding towards outpatient clinics would help a lot, especially from a stewardship perspective.”
Additionally, Nguyen says the providers in these individual clinics are not prepared for performing stewardship. There are some novel programs and third-party companies trying to bridge the gap between inpatient and outpatient settings, according to Nguyen, but he see there is a disconnect between outpatient settings and what providers would like to do in terms of stewardship.
“Outpatient providers want to provide stewardship. They want to optimize their patient care, but they just literally don't have the infrastructure or resources to provide that care.”
