Outpatient Antibiotic Stewardship Learning Session Explores Interventions and Patient-Provider Communication

Amid a nasty cold and flu season, UHF's Outpatient Antibiotic Stewardship Initiative held its second learning collaborative meeting on February 2 to discuss progress on work to improve prescribing for acute respiratory infections. Teams from seven hospitals and health systems across New York City shared updates on interventions they have implemented and the challenges they have faced in their efforts to establish robust antibiotic stewardship practices in the outpatient setting. Staff from IPRO, the New York State Department of Health, and the New York City Department of Health and Mental Hygiene also participated.

Despite widespread attention, antibiotic overuse and misuse—and the drug resistance it promotes—remains a critical challenge, one that is being addressed primarily among hospital inpatient and long-term care resident populations. The Outpatient Antibiotic Stewardship Initiative focuses instead on prescribing for adults with acute respiratory infections (ARIs) seen in 35 hospital-affiliated practices and clinics. The learning collaborative gives participants the opportunity to share their successes and challenges as they develop interventions based on data about each practice's prescribing patterns, gathered in an earlier phase of the initiative. Those interventions include implementing antibiotic stewardship best practices, and improved patient and provider education.

Belinda Ostrowsky, MD, co-led discussions with fellow faculty member Gopi Patel, MD.
The most common challenges noted at the learning session included adjusting workflow, staffing changes, and the use of electronic health records to foster better prescribing practices. Participants were particularly interested in creating and disseminating provider feedback reports: how such reports can be integrated into practices' quality improvement infrastructures was the focus of lively discussion moderated by faculty members Belinda Ostrowsky, MD, medical field officer for the division of health care quality and promotion at the Centers for Disease Control and Prevention, and Gopi Patel, MD, director of the antimicrobial stewardship program and associate professor at Mount Sinai Health System.

UHF staff also provided a summary of more than 700 patient surveys on antibiotic knowledge, distributed during this year's flu season, and more than 200 surveys, administered after visits for acute respiratory infection symptoms, on provider-patient communication. The surveys revealed gaps in knowledge about how and why antibiotics are used, with patients often arriving with preconceived ideas about their need for an antibiotic. Some session participants noted that the surveys were successful because they directly engaged patients, who perceived them as interesting and fun.

Dr. Rita Mangione-Smith, division chief of general pediatrics and hospital medicine at the University of Washington and director of the quality of care research fellowship at the Seattle Children's Hospital, discussed via webinar how to improve communication between patients and providers during visits for ARIs. She described a four-part communication strategy and learning models for training providers on how to manage patient expectations about antibiotic prescribing.

A final meeting of the initiative will be held in June to share further findings from the sites' interventions and discuss sustainability of those efforts.

March 2, 2018
Focus Area
Quality and EfficiencyClinical-Community Partnerships
Quality Institute