This year's flu season is the worst in almost a decade and still getting worse, according to federal officials. The viral illness is well-entrenched in every state but Hawaii, 37 children across the nation died from flu-related causes by late January, and New York declared a disaster emergency on January 25, after a record-high 7,800 cases were confirmed in the past week. All this means doctors across the nation are almost certainly getting pressure from hacking, sneezing, feverish patients to prescribe them antibiotics—because there is a lot more work to be done to educate the public that antibiotics do not work against viral colds and flu.
The Centers for Disease Control and Prevention (CDC) reports that approximately 44 percent of outpatient antibiotic prescriptions go to patients with acute respiratory conditions, such as colds, sore throats, bronchitis, allergies, influenza, and pneumonia. But an estimated half of these prescriptions are unnecessary, and contribute to the global problem of antibiotic resistance.
Even before the Obama Administration announced a National Action Plan for Combatting Antibiotic-Resistant Bacteria in 2015, United Hospital Fund, in partnership with Greater New York Hospital Association (GNYHA), began planning an antibiotic stewardship project to assess current practice and train physicians and pharmacists in proper hospital-based antibiotic use. Antibiotic stewardship, as defined by the CDC, refers to a set of actions designed to “optimize the treatment of infections while reducing the adverse events associated with antibiotic use.”
UHF has since expanded its program, and is now working to improve antibiotic prescribing for acute respiratory infections in outpatient care, and reduce incorrect prescribing in nursing homes.
In the outpatient setting, approximately 30 percent of antibiotics prescribed are unnecessary, especially in the case of acute respiratory infections. In nursing homes, which have a high rate of antibiotic prescribing because many residents are vulnerable to infections, approximately 40 to 75 percent of antibiotic prescriptions are inappropriate.
The UHF outpatient antibiotic stewardship initiative is a two-stage collaborative providing grant support to hospitals and health systems in New York City. In the first stage, 31 hospital outpatient sites assessed the status of antibiotic stewardship, gathered information on prescribers' knowledge and attitudes about antibiotics, and analyzed prescribing practices for adults with acute respiratory infections. The initiative incorporated both in-person meetings and webinar sessions to facilitate discussion about best practices among participants and experts.
Initial findings indicated an average antibiotic prescribing rate that was in line with national antibiotic prescribing rates, with a statistically significant variation across the hospitals and health systems. Antibiotics were prescribed for conditions such as bronchitis, which do not generally require those drugs. In the second stage of the initiative, currently underway, 35 hospital outpatient sites are using data from stage I to develop, pilot test, and evaluate interventions for antibiotic stewardship.
All the hospital outpatient sites are trying to improve patient education efforts. Intervention examples include providing handouts on managing cold symptoms, displaying waiting room videos on antibiotic use, and conducting follow-up calls to patients who did not receive antibiotics regarding their symptoms.
UHF also sponsored a nursing home certification program for antibiotic stewardship, in partnership with the GNYHA and the Society for Health System Pharmacists. An extension of the earlier inpatient-focused stewardship effort, this initiative has reached clinicians from over 40 nursing homes in New York, with both in-person meetings and webinars on antibiotic stewardship implementation strategies, and opportunities to share experiences with other nursing homes.
An estimated 2 million people in the United States acquire serious antibiotic-resistant infections each year, and 23,000 die as a result. With more global, national, and local attention on antibiotic resistance, as well as systematic initiatives in the health care setting focused on antibiotic stewardship, progress can be made to promote patient safety and reduce inappropriate antibiotic prescribing—even during flu season.
Pooja Kothari is a program manager for United Hospital Fund.