142 - Implementing an Antimicrobial Stewardship Program in the Outpatient Setting

Background: Antimicrobial-resistant infections lead to increased morbidity, mortality, and healthcare costs.  Among the most facile modifiable risk factors for developing resistance is inappropriate prescribing.  The CDC estimates that 47 million (or ≥30% of) outpatient antibiotic prescriptions in the United States are unnecessary.  This has provided impetus for expanding our antimicrobial stewardship program (ASP) into the outpatient setting.  Initial goals included the following: continuous evaluation and reporting of antibiotic prescribing compliance; minimize underuse of antibiotics from delayed diagnoses and misdiagnoses; ensure proper drug, dose, and duration; improve the percentage of appropriate prescriptions.

Methods: To achieve these goals, we first sent a baseline survey to outpatient prescribers, assessing their understanding of stewardship and antimicrobial resistance.  Questions were modeled from the Illinois Department of Public Health (IDPH) Precious Drugs & Scary Bugs Campaign.  The survey was sent to prescribers at 19 primary care and three immediate/urgent care clinics.  Compliance rates for prescribing habits were subsequently tracked via electronic health records and reported to prescribers in accordance with IRB approval.

Results: Prescribers were highly knowledgeable about what constitutes appropriate prescribing, with verified compliance rates highly concordant with self-reported rates.  However, 74% of respondents reported intense pressure from patients to inappropriately prescribe antimicrobials.  Compliance rates have been tracked since December 2018 and comparing pre- with post-intervention rates shows improvement in primary care since reporting rates to prescribers in August 2019.

Conclusion: Reporting compliance rates has been helpful in avoiding inappropriate antimicrobial therapy.  However, the survey data reinforce the importance of behavioral interventions to bolster ASP efficacy in the outpatient setting.  Going forward, posters modeled off of the IDPH template will be conspicuously exhibited in exam rooms, indicating institutional commitment to the enumerated ASP guidelines.  Future studies will allow for comparison of pre- and post-intervention knowledge and prescriber compliance.