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Impact of a Pharmacist-Led Emergency Department Urinary Tract Infection Aftercare Program

Federal Practitioner. 2024 September;41(9):302-305 | doi:10.12788/fp.0501
August 6, 2024|Federal Practitioner
Mia Vang, PharmD;Phuong Khanh T. Nguyen, PharmD, BCIDP;My-Phuong Pham, PharmD;Ashni Patel, PharmD, BCIDP;Jonathan Balakumar, MD;Joy Park, PharmD, BCPS
Author and Disclosure Information

Mia Vang, PharmDa; Phuong Khanh T. Nguyen, PharmD, BCIDPa; My-Phuong Pham, PharmDa; Ashni Patel, PharmD, BCIDPa; Jonathan Balakumar, MDa,b; Joy Park, PharmD, BCPSa

Correspondence: Jonathan Balakumar  (jonathanbalakumarmd@gmail.com)

aVeterans Affairs Greater Los Angeles Healthcare System, California

bDavid Geffen School of Medicine, University of California, Los Angeles

Author disclosures

The authors report no actual or potential conflicts of interest or outside sources of funding with regard to this article.

Disclaimer

The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.

Ethics and consent

This project was reviewed by the Veterans Affairs Greater Los Angeles Institutional Review Board and was determined to be exempt from research review.

Background: Current evidence demonstrates that a significant proportion of prescriptions for antibiotics that originate from the emergency department (ED) are inappropriate. Urinary tract infections (UTIs) are a frequent indication for prescribing an antibiotic in the ED. The Veterans Affairs Greater Los Angeles Healthcare System (VAGLAHS) piloted a pharmacist-led ED aftercare program to promote appropriate antimicrobial management of outpatient UTIs.

Methods: A single center, retrospective chart review included veterans discharged with an oral antibiotic for UTI treatment from the VAGLAHS ED and evaluated by clinical pharmacists between June 1, 2021, and June 30, 2022. For patients with multiple ED visits, only the initial ED encounter was reviewed. Patients were excluded if they had a complicated UTI diagnosis requiring intravenous antibiotics or if they were admitted to the hospital.

Results: Of 449 veterans with an index UTI ED aftercare follow-up, 200 patients were evaluated. A cystitis diagnosis was made for 132 patients (66.0%) and 121 (60.5%) were empirically prescribed ß-lactams. For 98 of 133 (73.6%) cases, appropriate empiric antibiotic selection led to no changes in index therapy. Sixty-seven cases required pharmacist intervention. Therapy modifications were made for 34 (17.0%) patients and 33 (16.5%) patients discontinued treatment. Discontinued therapy helped patients avoid 144 days of antibiotic exposure. Twelve (6.0%) patients had a subsequent urinary-related ED visit within 30 days.

Conclusions: Implementation of a pharmacist-driven UTI ED aftercare program at a US Department of Veterans Affairs medical center reduced unnecessary antimicrobial exposure and improved antibiotic management of UTIs.

Limitations

Inconsistent and incomplete documentation of clinical data in the electronic health record made the characterization of patient encounters challenging. Furthermore, ED HCPs varying clinical practices may have impacted the heterogeneity of UTI diagnosis and management at VAGLAHS.

 

Conclusions

Implementation of an ED pharmacist-driven UTI aftercare program at VAGLAHS reduced unnecessary antimicrobial exposure, improved antibiotic management, and ensured continuity of care postdischarge. Findings from our project implicate possible future pharmacist involvement predischarge, such as targeting inappropriate asymptomatic bacteriuria treatment.14-16 This pilot program suggested the feasibility of integrating antimicrobial stewardship practices within the ED setting in an ongoing effort to improve the quality of care for veterans.

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