A Two-Pronged Approach to Antibiotic Resistance

Overprescribing of antibiotics has become a critical public health problem in America, resulting in a sharp rise in antibiotic-resistant bacteria, and causing over two million infections and some 23,000 deaths each year. United Hospital Fund has been addressing this crisis on two tracks—gathering and analyzing data on prescribing patterns statewide, and working directly with hospital-based outpatient practices in New York City to promote more appropriate antibiotic prescribing.

Both projects focused on adult patients with acute respiratory infections, or ARIs, which are generally caused by viruses and thus not amenable to antibiotic treatment. Many factors have been cited as contributing to the continued prescribing of antibiotics for these conditions, including patient expectations of receiving one.

Recognizing that understanding the scope of the problem is a necessary first step toward solving it, UHF's Medicaid Institute has released a report on potentially inappropriate antibiotic prescribing for New York Medicaid beneficiaries, among the state's most vulnerable residents. The Right Prescription: Assessing Potentially Inappropriate Use of Antibiotics Among New York's Medicaid Population, funded by the New York State Department of Health, found significant variation in prescribing related to ARIs, based on patient location, race/ethnicity, and gender.

“These findings reveal a need for evidence-based, provider-level interventions specific to commonly diagnosed ARIs and commonly prescribed antibiotics,” the report states. Medicaid-specific strategies—such as quality improvement targets for value-based payment arrangements—might have potential as well, it noted.

Taking a hands-on approach, UHF's Quality Institute has completed the second phase of its Outpatient Antibiotic Stewardship Initiative, working with 34 hospital-affiliated practices from 7 health care systems to foster best practices in prescribing for adults with ARIs. Participants introduced interventions aimed at both patients and practitioners, including use of patient handouts and waiting room videos, provider feedback reports, and education on provider-patient communication.

Overall, antibiotic prescribing for these patients dropped 5 percentage points to 26 percent, which is below the national average. “Leadership support and actively engaged clinical champions played a key role by making stewardship a priority,” says UHF Director of Quality Improvement Joan Guzik. “But variations in rates among practices and for different patient groups indicate that more targeted work is needed.”