Some 30 percent of outpatient antibiotic use in the United States is estimated to be unnecessary, with many prescriptions written for respiratory conditions, such as acute bronchitis, for which antibiotics are generally not indicated. Such unwarranted use can contribute to the serious problem of increasingly common antibiotic resistance. United Hospital Fund's Outpatient Antibiotic Stewardship Initiative is working with seven hospitals and health systems across New York City to improve antibiotic prescribing for patients with acute respiratory infections in those providers' affiliated practices. To launch Stage II of the initiative, UHF recently hosted the first session of the Learning Collaborative that is at the heart of the project.
Keynote speaker Dr. Katherine Fleming-Dutra, a pediatrician and medical epidemiologist with the Centers for Disease Control and Prevention (CDC), presented the Core Elements of Outpatient Antibiotic Stewardship that the CDC released last year, and provided examples of evidence-based interventions to address each of those elements. Among those are educational materials for patients, who often expect or push for antibiotic prescriptions despite clinicians' understanding that the drugs are inappropriate (her presentation can be downloaded from the link to the right).
The session also featured participants' sharing of their experiences in implementing stewardship “best practices,” discussion of a planned survey to assess patient knowledge and attitudes about antibiotic use, and a “gallery walk” providing an overview of each team's project. A concluding discussion, moderated by Belinda Ostrowsky, MD, director of epidemiology, stewardship, and infection prevention and associate professor at Montefiore Health System, and Gopi Patel, MD, director of the antimicrobial stewardship program and associate professor at Mount Sinai Health System, addressed common issues such as use of clinical decision support and provider feedback.
During Stage I of the Initiative, which was started in February 2016 with $310,000 in UHF funding, data collected from 31 practices affiliated with nine health systems across New York City revealed considerable variation in prescribing practices for adult patients with acute respiratory infections even within a single health system. This year, UHF committed an additional $300,000 to Stage II, to help providers build on this data to develop and implement best practices in 35 affiliated sites.
Participants in Stage II are Medisys Health Network, Memorial Sloan Kettering Cancer Center, Montefiore Medical Center, Mount Sinai Health System, NewYork-Presbyterian Queens, NYU Langone Medical Center, and Wyckoff Heights Medical Center.