145 - Monthly Antibiotic Prescribing Peer Comparison Combined with In-person Education Decreases Antibiotic Prescribing for Acute Respiratory Infections

Background: Inappropriate antibiotic prescribing is an important modifiable risk factor for antibiotic resistance. Approximately half of all antibiotics prescribed for acute respiratory infections (ARIs) in the United States may be inappropriate or unnecessary. The purpose of this quality improvement (QI) project was to evaluate the effect of three consecutive interventions on improving antibiotic prescribing for ARIs (i.e., pharyngitis, rhinosinusitis, bronchitis, common cold).

Methods: This was a pre-post analysis of an antimicrobial stewardship QI initiative to improve antibiotic prescribing for ARIs in six Veterans Affairs (VA) primary care clinics.  Three distinct intervention phases occurred.  Educational interventions included training on appropriate antibiotic prescribing for ARIs.  During the first intervention period (8/2017-1/2019), education was presented virtually to primary care providers on a single occasion.  In the second intervention period (2/2019-10/2019), in-person education with peer comparison was presented on a single occasion.  In the third intervention period (11/2019-4/2020), education and prescribing feedback with peer comparison was presented once in-person followed by monthly emails of prescribing feedback with peer comparison.  January 2016-July 2017 was used as a pre-intervention baseline period.

The primary outcome was the antibiotic prescribing rate for all classifications of ARIs.  Secondary outcomes included adherence to antibiotic prescribing guidance for pharyngitis and rhinosinusitis.  Descriptive statistics and interrupted time series segmented regression were used to analyze the outcomes.

Results: Monthly antibiotic prescribing peer comparison emails in combination with in-person education was associated with a statistically significant 12.5% reduction in the rate of antibiotic prescribing for ARIs (p=0.0019).  When provider education alone was used, the reduction in antibiotic prescribing was nonsignificant.Rate of Antibiotic Prescribing for Acute Respiratory Infections


Conclusion: Education alone does not significantly reduce antibiotic prescribing for ARIs, regardless of the delivery mode. In contrast, education followed by monthly prescribing feedback with peer comparison was associated with a statistically significant reduction in ARI antibiotic prescribing rates.