NEW YORK, NEW YORK November 5, 2018— United Hospital Fund today released a comprehensive set of tools and guides designed to help outpatient practices appropriately prescribe antibiotics. The resource was produced to help combat antibiotic-resistant infections, one of the biggest public health risks of our time.
Each year, some two million people in the United States develop antibiotic-resistant infections, and 23,000 die as a result, according to the Centers for Disease Control and Prevention (CDC).
The CDC also estimates that about 150 million outpatient visits a year result in an antibiotic prescription—and a third of these prescriptions are unnecessary. To address this issue, United Hospital Fund launched an outpatient antibiotic stewardship grant initiative in 2016, partnering with over 30 hospital-owned outpatient practices from nine New York City health systems. The project aimed to improve prescribing practices for acute respiratory infections (ARIs), such as colds and bronchitis, which rarely respond to antibiotics.
The participants’ experiences were distilled and combined with UHF’s research to create Antibiotic Stewardship for Acute Respiratory Infections—The Milstein Toolkit for Ambulatory Care Practices. Howard P. Milstein provided support for the toolkit, which will be disseminated widely.
The toolkit contains data collection tools and surveys that allow outpatient practices to establish baseline information on their own antibiotic prescribing practices. There are overviews of the interventions implemented by participants in the project, lessons learned, and helpful tips for implementing those lessons. Also included are a patient survey, which is translated into six languages and can be used to assess patient knowledge of antibiotic resistance and proper use, and suggestions for educating patients on antibiotics.
“While many hospitals have addressed the misuse of antibiotics in the inpatient setting, antibiotic stewardship for outpatients has been very limited,” said Joan Guzik, MBA, UHF director of Quality Improvement, and co-author of the toolkit. “But we know that stewardship efforts in the outpatient setting work. Our initiative demonstrated that overall antibiotic prescribing rates for acute respiratory infections dropped 5 percentage points over the course of the program, to 26 percent.”
A UHF review of more than 1,000 New York City patient records from the outpatient practices that participated in the stewardship initiative illustrated the need for robust antibiotic stewardship programs. Published September 18, 2018 in the journal Infection Control & Hospital Epidemiology, the study found that providers prescribed antibiotics for nearly 67 percent of patients who had acute bronchitis and more than 80 percent for acute sinusitis—even though antibiotics are not usually indicated for these conditions. Overall, 37 percent of patients were prescribed antibiotics for acute respiratory infections, with the range of prescribing rates varying widely by site.
“Prior to participating in our initiative, only 11 percent of the practices had any outpatient-specific antibiotic stewardship activities,” said Pooja Kothari, RN, MPH, UHF program manager, and co-author of the toolkit. “But our findings demonstrated a statistically significant decline in antibiotic prescribing based on pre- and post-intervention data. Hopefully, practices that take advantage of our toolkit will find similar success.”
The toolkit is free of charge and can be downloaded from UHF’s website here.
Hospitals and health systems that participated in the outpatient antibiotic stewardship initiative include Interfaith Medical Center, MediSys Health Network, Memorial Sloan Kettering Cancer Center, Montefiore Medical Center, Mount Sinai Health System, NewYork-Presbyterian/Queens, NYU Langone Health, Northwell Health, and Wyckoff Heights Medical Center.
About United Hospital Fund
United Hospital Fund works to build a more effective health care system for every New Yorker. An independent, nonprofit organization, we analyze public policy to inform decision-makers, find common ground among diverse stakeholders, and develop and support innovative programs that improve the quality, accessibility, affordability, and experience of patient care. For more on our initiatives and programs, please visit our website at www.uhfnyc.org and follow us on Twitter.