Antibiotic Stewardship in the Urgent Care Setting Cuts Antibiotic Prescribing for Respiratory Encounters

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The urgent care (UC) setting is a prime target for antimicrobial stewardship efforts as it becomes an increasingly prevalent form of healthcare delivery.

As such, investigators with Intermountain Healthcare in Salt Lake City, Utah, sought to implement and analyze the efficacy of a UC stewardship program within their health system, where more than 50% of outpatient antibiotic use stems from UC antibiotic prescribing. Their interim analysis was presented at the virtual ID Week 2020.

Relying on the US Centers for Disease Control and Prevention’s (CDC) Core Elements of Antibiotic Stewardship as a guide, the research team crafted a UC stewardship program for Intermountain’s 39 UC sites, which was rolled out during a 12-month intervention period from July 2019 to June 2020.

The framework for the program involved education for patients/providers about appropriate diagnosis and prescribing for respiratory conditions, media campaigns, electronic health record tools, and a prescribing dashboard for clinicians.

Investigators’ primary end point was the percentage of respiratory visits where an antibiotic was prescribed, with secondary outcomes including the percentage of encounters receiving antibiotics for conditions where no antibiotics are indicated (such as bronchitis) and the percentage of encounters receiving first-line recommended therapy for conditions in which antibiotics may be warranted (otitis media, sinusitis, and pharyngitis).

Using a binomial mixed effects hierarchical model, the research team calculated the odds of antibiotic prescribing associated with the intervention period, taking into account pre-intervention trends (pre-intervention period August 2017 to June 2019).

After 7 months of intervention, evaluating 1,559,403 UC encounters over the course of the study period, a system-wide and multifaceted antibiotic stewardship program based on the CDC Core Elements was found to be successful in reducing antibiotic overuse for respiratory conditions. A total of 41.5% of UC encounters during the study period were for respiratory conditions. The number of patients with respiratory conditions that received an antibiotic prescription declined from 49.9% pre-intervention to 35.3% during the intervention (OR 0.73, 95% CI: 0.71, 0.76). The percentage reached a low of 30% in February 2020.

Also during the intervention, recommendation of first-line therapy increased (OR 1.28, 95% CI 1.20-1.26) and prescribing for conditions where antibiotics are not indicated decreased (OR 0.31, 95% CI 0.26-0.36).

“Despite a nearly 20% absolute reduction in antibiotic prescriptions for respiratory encounters, there were no detectable harms for patients in terms of adverse clinical outcomes or in patient satisfaction,” Adam Hersh, MD, PhD, pediatric infectious diseases physician at the University of Utah and presenting author, told Contagion®. “We are now focused on strategies for sustainability. We are also expanding this approach to other conditions and other outpatient settings.”

The study, “SCORE-UC: Antibiotic Stewardship in Urgent Care,” was presented virtually at ID Week 2020.