Amy Fabian, PharmD, BCPS: Pharmacist Impact on Antimicrobial Prescribing in Outpatient Setting

At the Making a Difference in Infectious Diseases annual meeting (MAD-ID 2019), Amy Fabian, PharmD, BCPS, PGY-2 infectious diseases pharmacy resident at St. Joseph's Health, presented research on the effect of pharmacist presence on antibiotic prescribing in the urgent care setting,

Fabian sat down with Contagion® to discuss her key findings and plans for future research avenues.

Contagion®: Can you discuss what the driving factors were behind the decision to embark on this study on pharmacist impact on antimicrobial prescribing in the urgent care setting?

Dr. Fabian: From as long as I can remember, even just interning in an outpatient pharmacy which actually had an urgent care under the same roof when I was in pharmacy school, I just saw the number of prescriptions coming from that urgent care center, all the azithromycin. It just seemed like all of the patients were getting the same prescriptions, the same antibiotics. Even as a student, I wondered what the practice would look like if a pharmacist was working a little more closely with those providers, which were primarily mid-level practitioners, nurse practitioners and physicians assistants, at that specific clinic.

My institution now has a really well-developed antibiotic stewardship program for the inpatient setting, and so some of the things that we’ve been looking at have really been to explore what’s going on in the outpatient setting and to see where we can impact antibiotic stewardship there. I’ve been really excited to hear a lot of people really drawing attention to that, even at this conference. Today, many of the speakers have been talking about the issue that is over-prescribing of antibiotics in the outpatient setting.

I think earlier this year when that study was published in JAMA Internal Medicine showing the inappropriate prescribing of antibiotics taking place in ambulatory settings and specifically in urgent cares it really was kind of what drove me to see what we could be doing in an urgent care center.

Contagion®: What were the key findings of your study?

Dr. Fabian: What my study basically found was that an antibiotic stewardship pharmacist’s presence in an urgent care center did reduce non-compliance with antibiotic prescribing recommendations for UTIs, skin and soft tissue infections, and upper and lower respiratory tract infections. Non-compliance actually reduced from 43% to 31% while I was there in the urgent care center and this was statistically significant. The biggest impact was really made in a reduction of the proportion of patients who were prescribed an antibiotic when 1 was not indicated and that group of patients was the lower respiratory tract infections, so our acute bronchitis patients, was really where the biggest impact was made.

Contagion®: Are there any plans for future studies on this topic?

Dr. Fabian: In the immediate 4 weeks following my intervention, it seemed like the rates of non-compliance maintained steady, so I think future directions for this type of research are going to be to look at potentially cost-justifying positions in the outpatient and seeing where we can get the resources to really enhance outpatient antibiotic stewardship. Further directions are to see really what happens in 3 months or 6 months as we get new providers. I don’t think 1 month is really going to be enough to sustain for several years or several months. It would be interesting to see what happens in 6 months from now. We’re currently working on further data analysis to control for variation with providers between the groups and doing some further statistics for the publication.

The study, “Evaluation of a Pharmacist’s Impact on Antimicrobial Prescribing in an Urgent Care Center,” was presented at MAD-ID 2019, held May 8-11, 2019, in Orlando, Florida.