Antibiotic Stewardship Improvement Initiative at a Veterans Health Administration Ambulatory Care Center
Background: The negative impact of unnecessary antibiotic prescribing is well known and includes risks of antibiotic adverse effects, overgrowth of pathogenic organisms, unnecessary costs, and selection of antibiotic-resistant organisms in the populace at large. Acute viral respiratory infections are among the leading causes of inappropriate antibiotic usage.
Methods: This study examined the effect on inappropriate antibiotic prescribing rates of educating clinicians regarding antibiotic stewardship and making a prepackaged kit (containing symptom relief and patient education) for clinicians to distribute to patients with viral upper respiratory tract infections vs writing a prescription for antibiotics.
Results: Between December 1, 2018, and March 31, 2019, 357 viral illness support packs were distributed. Antibiotic prescriptions for the diagnostic codes pertaining to viral upper respiratory tract infections were tracked and compared to a similar period from December 1, 2017, to March 31, 2018. A 9% reduction in antibiotic prescriptions was observed (P = .02).
Conclusions: The results of this project demonstrate that the combination of patient education and the ready availability of a nonantibiotic symptomatic treatment option can significantly decrease the unnecessary prescribing of antibiotics for viral illnesses.
The pamphlet Viral Illness Support Pack Traffic Light Card (eAppendix available online at doi:10.12788/fp.0302) provides important clinical information to the patients about their illness. Patients are instructed to contact their primary care team if they are worse after 3 days of illness; symptoms are not improving after 10 days; or they experience blood in respiratory secretions, chills or generalized aching, and localized pain that is one-sided or significantly worsening. Patients are clearly informed to seek further care if not improving with symptomatic treatment.
The ability to provide patients with symptomatic relief, including throat lozenges, lip balm, and acetaminophen, was felt to be important in the success of the project. Furthermore, this eliminated an extra step of the patient needing to visit the pharmacy.
Limitations
Limitations of the study included starting distribution of the support packs somewhat after the onset of the viral illness season, failure to reach all prescribers for academic detailing at the start of the program, and several instances of temporary unavailability of the support packs in some areas.
Conclusions
Patients with ARIs are often significantly symptomatic and frequently believe that they require an antibiotic for treatment. Clinicians may adjust their behavior in response to their patients’ expectations, stated or unstated. The results of this project demonstrate that the combination of patient education and the ready availability of a nonantibiotic symptomatic treatment option can significantly decrease the unnecessary prescribing of antibiotics for viral illnesses.
Acknowledgments
The authors are grateful to Ms. Traci Washington for assistance in sourcing materials; to Karen Corr, PhD, and Anthony Restuccio, MD, for advice on methods; to Mr. Daniel Pignatelli for assistance with data interpretation; and to Mr. Keith Skidmore, Ms. Crystal Conley, and Ms. Megan Harris for assistance with assembling the Viral Illness Support Packs.
