Implementing Strategies and Measuring Interventions to Reduce Antimicrobial Stewardship Disparities
In the second installment of the discussion around the Equity in Antimicrobial Stewardship Efforts (EASE), the codevelopers of this novel framework discuss how to move forward with interventions and measuring success around them.
It is one thing to identify a problem, but it is another to identify the problem and offer interventional strategies to overcome it as well as find ways to measure them. This is exactly what Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP, assistant professor of Clinical Pharmacy, University of California San Diego, and Jasmine Marcelin, MD, FACP, FIDSA, associate professor, Department of Internal Medicine, associate medical director, Antimicrobial Stewardship Program, University of Nebraska Medical Center have put forth with their new novel framework titled Equity in Antimicrobial Stewardship Efforts (EASE). It was launched earlier this month, and detailed comprehensively in Antimicrobial Stewardship & Healthcare Epidemiology.
EASE is broken down into 5 priorities, and they include the following:
- Priority 1: Identify Existing AS Inequities
- Priority 2: Healthcare Team Education
- Priority 3: Design AS Intervention to Address Inequities
- Priority 4: Measure Intervention Outcomes
- Priority 5: Disseminate Findings and Change Policies1
In the first part of a 2-part interview, Abdul-Mutakabbir and Marcelin offered insights on the recent history of inequities around antimicrobial prescribing practices as well as some feedback on the first 2 priorities. In this second part of the interview, they offer commentary on the last 3 priorities including designing, measuring, and disseminating findings.
Priority 3: Design AS Intervention to Address Inequities
Marcelin says the third step is about finding a specific area to address. She uses the example of finding an area within a clinic or area within the hospital that may already have processes, but may need modification.
“What are the processes that are already in place in the hospital that can then be applied to antimicrobial stewardship and prescribing practices, so you don't have to reinvent the wheel,” Marcelin said. “And you can make really key collaborations that will overall impact the patient care and hospital quality approaches, because a lot of these patients have overlapping conditions. And so that's 1 way of really focusing quality improvement on the whole, rather than 1 individual thing.”
Priority 4: Measure Intervention Outcomes
In thinking about a novel intervention, Abdul-Mutakabbir points to an example of a study that looked at the inner city of Chicago and people of minoritized communities who were more likely to visit the emergency department. This was during the pandemic and the investigators of the intervention wanted to make sure patients were receiving COVID-19 monoclonal antibodies equitably.
In measuring the outcome, the investigators decided upon a number associated with interventions in the ER. “Their outcome of focus was the number of racially ethnically minoritized individuals that went ahead and received those monoclonal antibodies after that placement of this intervention into the emergency department,” Abdul-Mutakabbir said. “So I think that it really begins with you have to identify that area that you're going to focus in on. And then when you're designing that intervention, selecting those outcomes that you want to continue to follow.”
Priority 5: Disseminate Findings and Change Policies
The last step in the process is publicizing results. This allows for more widespread understanding and the possibility of other groups looking at committing to these types of interventions.
“The widespread dissemination of the findings and strategies utilized in the intervention is important for the continued learning and growth of equity-focused AS, universally,” the authors wrote. “Promoting advancements in this area can include a variety of activities such as including equity-focused sessions in scientific conference programming or soliciting research articles that describe AS inequities and/or describe equity-focused AS interventions. The consistent production and amplification of data that displays AS disparities will further emphasize the need for public attention and governmental funding to support continued research and advocacy for health equity.”
“I would love to see our hospitals and antimicrobial stewardship programs really embrace this as a priority in the same way that they have other important quality improvement initiatives. Because at the end of the day, the whole point of this is to ensure that all patients have equitable access to care, equitable access to antimicrobials when they need it, and not getting extra stuff when they don't need it,” Marcelin said.
This is the second installment in a two-part interview. In the first installment, Abdul-Mutakabbir and Marcelin discuss some of the challenges in antimicrobial prescribing practices and the priorities of the framework.
