Hidden Challenges to Implementing Antimicrobial Stewardship Programs in the Outpatient Setting

Nathan A. Everson, PharmD, AAHIVE, infectious disease pharmacist at Carilion Clinic, Roanoke Memorial Hospital, shares some hidden challenges clinicians should address when implementing antibiotic stewardship interventions in the outpatient setting.

Interview transcript (slightly modified for readability):

I think that when you are going from the inpatient to the outpatient side [one of the things you're] worried about is access, and it becomes a much bigger deal than you’re probably used to thinking on the inpatient side. We know we worry about that on discharge, but even getting to that first dose, you have to worry about patients being able to get the medication that’s the right choice for them, in terms of affordability and that sort of thing. That adds a whole layer of complexity that you’re not used to.

You’re also working with a lot less information about that patient, in terms of basing recommendations, sometimes you have a lot fewer laboratory values, you may not even have a great way of having a good dialogue with the patient necessarily. I think dealing with outpatient stewardship you have concerns that you sometimes get on the inpatient side, but maybe more so on the outpatient side. In terms of, people being comfortable with infectious disease sites, being current, people knowing what the most current medications are and having a great way of disseminating information to that outpatient setting. We’ve done a great job on the inpatient side of doing treatment guidelines and getting antibiograms in the hands of our providers and getting them on the same page in terms of the right way to treat infections. However, I think we don’t necessarily have a great way of communicating with a very large disparate group of outpatient practices in terms of getting people on that same page.