The Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use: Antibiotic Stewardship Implementation in 63 United States Pediatric Practices During the COVID-19 Pandemic

Purpose/Objectives: The AHRQ Safety Program for Improving Antibiotic Use aimed to improve antibiotic use by engaging clinicians and staff to incorporate antibiotic stewardship principles into practice culture, communication, and decision making. We report on changes in visits and antibiotic prescribing among participating pediatric primary and urgent care ambulatory practices during the COVID-19 pandemic.

Design/Methods: The Safety Program used webinars, audio presentations, educational tools, and office hours to engage clinician champions and staff leaders to: (a) establish antibiotic stewardship programs, (b) address attitudes and culture that pose challenges to judicious antibiotic prescribing, and (c) incorporate best practices for the management of common infections into their workflow using the Four Moments of Antibiotic Decision Making framework. Monthly data on total visits (in-person and virtual), acute respiratory infection (ARI) visits, and antibiotic prescribing were collected from all participating practices during the pre-intervention period (September 2019-November 2019) and during the Safety Program (December 2019-November 2020). Data from the beginning to the end of the Safety Program were compared using linear mixed models to account for random effects of participating sites and repeated measurements of outcomes within practices over time.

Results: The 63 participating pediatric practices included 23 general pediatric clinics (37%) and 40 pediatric urgent care clinics (63%). 60 practices submitted complete data for analysis, including 1,040,810 visits. Visits/practice-month declined March-April 2020 but exceeded baseline by Safety Program end (Figure 1). Total antibiotic prescribing declined by 16 prescriptions/100 visits (95% CI: -18 to -14) from November 2019 and November 2020. ARI visits/practice-month similarly declined March-June 2020 after widespread recognition of the COVID-19 epidemic, and remained below baseline by Safety Program end (Figure 2). ARI-related antibiotic prescriptions decreased by 16 prescriptions/100 ARI visits (95% CI: -20 to -12) from November 2019 to November 2020. Among antibiotic classes, the greatest change was in penicillins. Prescriptions for penicillins was reduced by 11 prescriptions/100 ARI visits (95% CI: -14 to -8).

Conclusion/Discussion: During the COVID-19 pandemic, while visit rates gradually normalized, a national ambulatory Antibiotic Stewardship program was associated with declines in overall and ARI-related antibiotic prescribing.