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- (-) Ambulatory Care and Surgery (16)
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- Antimicrobial Stewardship (12)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 16 of 16 Research Studies DisplayedBrown T, Lee JY, Guzman A
Prevalence and appropriateness of in-person versus not-in-person ambulatory antibiotic prescribing in an integrated academic health system: a cohort study.
This retrospective cohort study examined the prevalence and appropriateness of all ambulatory antibiotic prescribing in an integrated health delivery system in the United States. The authors looked at prescribing at in-person visits and not-in-person visits (e.g. telephone, refills). Prescribing was divided into the following 5 appropriateness groups: 1) chronic antibiotic use; 2) antibiotic-appropriate; 3) potentially antibiotic-appropriate; 4) non-antibiotic-appropriate; and 5) not associated with a diagnosis. Over the 4-year study period, there were 714,057 antibiotic prescriptions ordered for 348,739 unique patients by 2,391 clinicians in 467 clinics with a patient population with a mean age of 41 years, 61% female and 78% White. Clinicians were mostly women (58%); were 78% physicians; and of those physicians were 42% primary care, 39% medical specialists, and 12% surgical specialists. The vast majority (81%) of antibiotics were prescribed at in-person visits, and 19% were not in-person visits (10% telephone, 5% orders only, and 3% refill encounters). Prescribing appropriateness was divided into 16% for chronic use, 15% antibiotic-appropriate, 39% potentially antibiotic-appropriate, 22% non-antibiotic-appropriate, and 8% not associated with a diagnosis. Prescription of antibiotics not-in-person were more likely to be chronic (20% versus 15%); less likely to be associated with appropriate or potentially appropriate diagnoses (30% versus 59%) or non-antibiotic-appropriate diagnoses (8% versus 25%); and more likely to be associated with no diagnosis (42% versus <1%).
AHRQ-funded; HS024930.
Citation: Brown T, Lee JY, Guzman A .
Prevalence and appropriateness of in-person versus not-in-person ambulatory antibiotic prescribing in an integrated academic health system: a cohort study.
PLoS One 2023 Jul 27; 18(7):e0289303. doi: 10.1371/journal.pone.0289303..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Ambulatory Care and Surgery
Kakiuchi S, Perencevich EN, Livorsi DJ
Is the number of prescriptions an appropriate metric for outpatient antimicrobial consumption? A comparison between the prescription counts and days supplied.
Monitoring antibiotic use is essential for encouraging the appropriate use of antibiotics. However, defining appropriate metrics presents multiple challenges. The purpose of this study was to compare 2 metrics for antibiotic outpatient consumption at the Veterans Health Administration (VHA) pharmacies: the number of prescriptions in EMRs and the number of dispensed days, or days supplied. During the study period, 13,373,460 clinic visits (5.0%) of the 265,613,607 total clinic visits had an antibiotic prescription, and the total of days supplied was 182,793,572. The study found that the mean days supplied per prescription continued mainly unchanged during the study period. Comparing the number of prescriptions and days supplied normalized by the number of clinic visits, these 2 metrics changed in parallel, with only minor differences from 2010 to 2019. When the researchers focused on short-term prescriptions usually utilized for acute illnesses (14 days or less), prescription number and days supplied reflected an increasing discrepancy. The number of prescriptions underestimated the decline compared to days supplied. Alternatively, long-term prescriptions (15 days or more) reflected the opposite discrepancy. For comparisons between facilities, the researchers found considerable differences in rankings of healthcare systems based on the 2 metrics.
AHRQ-funded; HS027472.
Citation: Kakiuchi S, Perencevich EN, Livorsi DJ .
Is the number of prescriptions an appropriate metric for outpatient antimicrobial consumption? A comparison between the prescription counts and days supplied.
Infect Control Hosp Epidemiol 2023 Jun; 44(6):941-44. doi: 10.1017/ice.2022.189..
Keywords: Medication, Ambulatory Care and Surgery, Antibiotics, Antimicrobial Stewardship
Keller S, Miller MA, Cosgrove SE
AHRQ Author: Miller MA
The AHRQ Safety Program for Improving Antibiotic Use in Practice.
The Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use was an antibiotic stewardship intervention implemented across the United States in 2020 in 389 primary and urgent care practices. The AHRQ Toolkit to Improve Antibiotic Use in Ambulatory Care has been created based on integration of the educational material used in the AHRQ safety program and the experiences of the participating practices. The toolkit includes presentations on developing, implementing, and maintaining antibiotic stewardship activities; a gap analysis tool; and a guide to accessing and reporting antibiotic prescription data. Practices can use these tools to build their antibiotic stewardship teams and begin working on programs. Improving antibiotic prescribing in ambulatory care is a critical need. Utilizing the AHRQ Toolkit to Improve Antibiotic Use in Ambulatory Care can assist practices in achieving their antibiotic stewardship goals.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Keller S, Miller MA, Cosgrove SE .
The AHRQ Safety Program for Improving Antibiotic Use in Practice.
Am Fam Physician 2023 May; 107(5):456-57..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Ambulatory Care and Surgery, Tools & Toolkits
Jindai K, Itaya T, Ogawa Y
Decline in oral antimicrobial prescription in the outpatient setting after nationwide implementation of financial incentives and provider education: an interrupted time-series analysis.
Researchers examined the impact of financial incentives to providers and provider education on overall antimicrobial prescription rates. They also analyzed how nationwide outpatient antimicrobial stewardship interventions in cases where antimicrobials were deemed unnecessary for uncomplicated respiratory infections and acute diarrhea affected different age groups before and after their implementation. The results indicated that prescription rates for all age groups showed a downward trend throughout the study period. Substantial reductions in prescription rates were observed among infants under 2 years, while provider education immediately reduced prescription rates in all age groups uniformly. Interventions did not affect the long-term trend for any age group.
AHRQ-funded; HS027472.
Citation: Jindai K, Itaya T, Ogawa Y .
Decline in oral antimicrobial prescription in the outpatient setting after nationwide implementation of financial incentives and provider education: an interrupted time-series analysis.
Infect Control Hosp Epidemiol 2023 Feb; 44(2):253-59. doi: 10.1017/ice.2022.49..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Ambulatory Care and Surgery
Guzman A, Brown T, Lee JY
Look-back and look-forward durations and the apparent appropriateness of ambulatory antibiotic prescribing.
Researchers assessed how the apparent appropriateness of antibiotic prescribing changes when using different look-back and look-forward periods. Classifying all ambulatory antibiotic prescriptions in the electronic health record of an integrated health care system as chronic, appropriate, potentially appropriate, inappropriate, or not associated with any diagnosis, they concluded that ambulatory programs and studies focused on appropriate or inappropriate antibiotic prescribing can reasonably use a short duration of association between an antibiotic prescription and diagnosis codes. They further indicated that programs and studies focused on potentially appropriate antibiotic prescribing might consider examining longer durations.
AHRQ-funded; HS024930.
Citation: Guzman A, Brown T, Lee JY .
Look-back and look-forward durations and the apparent appropriateness of ambulatory antibiotic prescribing.
Antibiotics 2022 Nov 4;11(11). doi: 10.3390/antibiotics11111554..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Ambulatory Care and Surgery, Practice Patterns
Keller SC, Cosgrove SE, Miller MA
AHRQ Author: Miller MA
A framework for implementing antibiotic stewardship in ambulatory care: lessons learned from the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use.
This article used lessons learned from AHRQ’s Safety Program for Improving Antibiotic Use in Ambulatory Care to describe a step-by-step framework that assists practices with establishing antibiotic stewardship in outpatient settings. These steps include: obtaining support from practice leadership; establishing antibiotic stewardship teams; garnering support from practice members; building communication skills around antibiotic use; implementing educational content around an infectious syndrome; accessing and monitoring antibiotic prescribing data; and implementing a sustainability plan.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Keller SC, Cosgrove SE, Miller MA .
A framework for implementing antibiotic stewardship in ambulatory care: lessons learned from the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use.
Antimicrob Steward Healthc Epidemiol 2022 Jul 4;2(1):e109. doi: 10.1017/ash.2022.258..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Ambulatory Care and Surgery, Patient Safety
Nielsen TB, Santarossa M, Probst B
Introducing antimicrobial stewardship to the outpatient clinics of a suburban academic health system.
This study’s objective was to determine attitudes of prescribers of antimicrobials to help establish an antimicrobial stewardship program in the outpatient setting. Participants included prescribers at Loyola University Health System, an academic teaching healthcare system with 19 primary care and 3 intermediate- and urgent-care clinics. A voluntary survey was developed using SurveyMonkey and was distributed via email. Data were conducted anonymously. Three metrics were assessed for rates of compliance and included: (1) avoidance of antibiotics in adult acute bronchitis and appropriate antibiotic treatment in (2) patients tested for pharyngitis and (3) children with upper respiratory tract infections. Prescribers were very knowledgeable about what constitutes appropriate prescribing, but fewer than half believed antibiotics were overprescribed in their office. The respondents reported that 74% received intense pressure from patients to prescribe antimicrobials inappropriately. Intermediate- and urgent-care prescribers had higher rates of compliance than primary-care prescribers. However, the latter group responded well to monthly reports and online educational resources.
AHRQ-funded; HS025690.
Citation: Nielsen TB, Santarossa M, Probst B .
Introducing antimicrobial stewardship to the outpatient clinics of a suburban academic health system.
Antimicrob Steward Healthc Epidemiol 2022;2(1):e9. doi: 10.1017/ash.2021.228..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Ambulatory Care and Surgery
Fritz SA, Shapiro DJ, Hersh AL
National trends in incidence of purulent skin and soft tissue infections in patients presenting to ambulatory and emergency department settings, 2000-2015.
This study looked at national trends in the incidence of outpatient visits for skin infections from 2000-2015, which peaked in 2010-2013, followed by a plateau in 2014 and 2015. Cephalexin was the most frequently prescribed antibiotic at the beginning of the study, with trimethoprim-sulfamethoxazole then becoming the most frequently prescribed by the end of the study period.
AHRQ-funded; HS021736; HS024269.
Citation: Fritz SA, Shapiro DJ, Hersh AL .
National trends in incidence of purulent skin and soft tissue infections in patients presenting to ambulatory and emergency department settings, 2000-2015.
Clin Infect Dis 2020 Jun 10;70(12):2715-18. doi: 10.1093/cid/ciz977..
Keywords: Skin Conditions, Ambulatory Care and Surgery, Emergency Department, Antibiotics, Medication
Rowe TA, Linder JA
Delayed antibiotic prescriptions in ambulatory care: reconsidering a problematic practice.
In this paper, the authors discuss delayed or backup antibiotic prescriptions, which are given to ambulatory patients with the expectation that the patient will pick up or fill the prescription if he or she is not improving within a few days. They discuss the drawbacks of delayed antibiotic prescriptions and the options for clinicians.
AHRQ-funded; HS024930; HS026506; 2332015000201.
Citation: Rowe TA, Linder JA .
Delayed antibiotic prescriptions in ambulatory care: reconsidering a problematic practice.
JAMA 2020 May 12;323(18):1779-80. doi: 10.1001/jama.2020.2325..
Keywords: Antibiotics, Medication, Ambulatory Care and Surgery, Medication: Safety, Patient Safety, Antimicrobial Stewardship
Kohut MR, Keller SC, Linder JA
AHRQ Author: Miller MA
The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting.
Researchers conducted semi-structured interviews with clinicians to determine how they perceive demand for antibiotics in the outpatient setting. They conducted interviews with 25 clinicians from nine practices across three states. Patient demand was the most common reason why non-indicated antibiotics were prescribed. Clinicians felt that if they didn’t prescribe them they would experience repercussions in their reputation and practice and that certain patients are impossible to please without an antibiotic prescription regardless of the diagnosis.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Kohut MR, Keller SC, Linder JA .
The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting.
Fam Pract 2020 Mar 25;37(2):276-82. doi: 10.1093/fampra/cmz066..
Keywords: Antibiotics, Medication, Antimicrobial Stewardship, Ambulatory Care and Surgery, Provider: Clinician, Provider: Physician, Provider
Chua KP, Fischer MA, Linder JA
Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study.
This study used ICD-10 codes to determine the appropriateness of outpatient antibiotic prescriptions filled in privately insured patients in the US. Determinations were made based on diagnosis whether the prescriptions were “appropriate”, “potentially appropriate”, “inappropriate”, or no diagnosis code found. Among a cohort of over 19 million, only 12.8% were deemed appropriate, 23.2% were inappropriate, 35.5% potentially inappropriate, and 28.% not associated with a diagnosis code.
AHRQ-funded; HS024930; 233201500020I.
Citation: Chua KP, Fischer MA, Linder JA .
Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study.
BMJ 2019 Jan 16;364:k5092. doi: 10.1136/bmj.k5092..
Keywords: Ambulatory Care and Surgery, Antibiotics, Shared Decision Making, Health Insurance, Medication
Hersh AL, Olson J, Stockmann C
Impact of antimicrobial stewardship for pediatric outpatient parenteral antibiotic therapy.
In this study, the investigators developed an outpatient parenteral antibiotic therapy (OPAT) stewardship program in a freestanding children's hospital to improve the appropriateness of OPAT prescribing.
AHRQ-funded; HS023320.
Citation: Hersh AL, Olson J, Stockmann C .
Impact of antimicrobial stewardship for pediatric outpatient parenteral antibiotic therapy.
J Pediatric Infect Dis Soc 2018 May 15;7(2):e34-e36. doi: 10.1093/jpids/pix038..
Keywords: Antibiotics, Antimicrobial Stewardship, Children/Adolescents, Ambulatory Care and Surgery
Keller SC, Tamma PD, Cosgrove SE
AHRQ Author: Miller MA
Ambulatory antibiotic stewardship through a human factors engineering approach: a systematic review.
The authors conducted a systematic review to identify controlled interventions and qualitative studies of ambulatory antibiotic stewardship (AS) interventions and determine whether and how they incorporated principles from a human factors engineering model, the Systems Engineering Initiative for Patient Safety 2.0 model. They concluded that studies have not focused on clinic-wide approaches to AS.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Keller SC, Tamma PD, Cosgrove SE .
Ambulatory antibiotic stewardship through a human factors engineering approach: a systematic review.
J Am Board Fam Med 2018 May-Jun;31(3):417-30. doi: 10.3122/jabfm.2018.03.170225.
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Keywords: Antibiotics, Clinical Decision Support (CDS), Primary Care: Models of Care, Ambulatory Care and Surgery, Patient Safety
Goldman JL, Richardson T, Newland JG
Outpatient parenteral antimicrobial therapy in pediatric Medicaid enrollees.
The study’s objective was to characterize outpatient parenteral antimicrobial therapy (OPAT) use and clinical outcomes for a large population of pediatric Medicaid enrollees treated with OPAT. It found that ceftriaxone and vancomycin were the most commonly prescribed antimicrobials. An emergency department visit or hospital admission occurred during 38 percent of OPAT episodes, among which 61 percent were OPAT-related.
AHRQ-funded; HS023320.
Citation: Goldman JL, Richardson T, Newland JG .
Outpatient parenteral antimicrobial therapy in pediatric Medicaid enrollees.
J Pediatric Infect Dis Soc 2017 Mar 1;6(1):65-71. doi: 10.1093/jpids/piv106.
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Keywords: Antibiotics, Children/Adolescents, Medicaid, Ambulatory Care and Surgery, Patient-Centered Outcomes Research
Cunha CB, D'Agata EM
Implementing an antimicrobial stewardship program in out-patient dialysis units.
The purpose of this review is to highlight the key elements and interventions of antimicrobial stewardship programs (ASP). The Infectious Disease Society of America and the Society of Healthcare Epidemiology of America have provided evidence-based guidelines for the development and implementation of an ASP. Many of their recommendations can be adapted to the out-patient dialysis setting.
AHRQ-funded; HS021666.
Citation: Cunha CB, D'Agata EM .
Implementing an antimicrobial stewardship program in out-patient dialysis units.
Curr Opin Nephrol Hypertens 2016 Nov;25(6):551-55. doi: 10.1097/mnh.0000000000000281.
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Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Ambulatory Care and Surgery, Kidney Disease and Health, Chronic Conditions
Wares JR, Lawson B, Shemin D
Evaluating infection prevention strategies in out-patient dialysis units using agent-based modeling.
The researchers hypothesized that targeting patients receiving antimicrobial treatment would more effectively reduce transmission and acquisition of multidrug-resistant organisms (MDRO) and further that environmental contamination plays a role in the dissemination of MDRO in the dialysis unit. They found that reducing antimicrobial treatment markedly reduces overall colonization rates and also the levels of environmental contamination in the dialysis unit. They suggested that improving the environmental decontamination efficacy between patient dialysis treatments as an effective method for reducing colonization and contamination rates.
AHRQ-funded; HS021666.
Citation: Wares JR, Lawson B, Shemin D .
Evaluating infection prevention strategies in out-patient dialysis units using agent-based modeling.
PLoS One 2016 May 19;11(5):e0153820. doi: 10.1371/journal.pone.0153820.
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Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Healthcare-Associated Infections (HAIs), Prevention, Ambulatory Care and Surgery, Infectious Diseases