ArticleBMJ open quality2021
Operationalising outpatient antimicrobial stewardship to reduce system-wide antibiotics for acute bronchitis.
Article in BMJ open quality, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 10 citations in OpenAlex.
- Combating Antimicrobial Resistance: A Pharmacist-Led PDCA Stewardship Program in a Tertiary Hospital.Infection and drug resistance · 2026Article
- Quality improvement initiative to reduce URI-associated antibiotic prescriptions among adult primary care providers.BMJ open quality · 2024Article
- Leveraging Health Systems to Expand and Enhance Antibiotic Stewardship in Outpatient Settings.Joint Commission journal on quality and patient safety · 2024Article
- Successful adaptation of an initiative to reduce unnecessary antibiotics for acute respiratory infections across two Veteran Affairs ambulatory healthcare systems.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2024Article
- Evaluation of Multisite Programmatic Bundle to Reduce Unnecessary Antibiotic Prescribing for Respiratory Infections: A Retrospective Cohort Study.Open forum infectious diseases · 2023Article
- It's about the patients: Practical antibiotic stewardship in outpatient settings in the United States.Frontiers in medicine · 2022Review
- Association of antibiotics with veteran visit satisfaction and antibiotic expectations for upper respiratory tract infections.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2022Article
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Authors and funding
10 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAntibiotics are not recommended for treatment of acute uncomplicated bronchitis (AUB), but are often prescribed (85% of AUB visits within the Veterans Affairs nationally). This quality improvement project aimed to decrease antibiotic prescribing for AUB in community-based outpatient centres from 65% to <32% by April 2020.
methodsFrom January to December 2018, community-based outpatient clinics' 6 months' average of prescribed antibiotics for AUB and upper respiratory infections was 63% (667 of 1054) and 64.6% (314 of 486) when reviewing the last 6 months. Seven plan-do-study-act (PDSA) cycles were implemented by an interprofessional antimicrobial stewardship team between January 2019 and March 2020. Balancing measures were a return patient phone call or visit within 4 weeks for the same complaint. Χ
resultsThe AUB antibiotic prescribing rate decreased from 64.6% (314 of 486) in the 6 months prior to the intervention to 36.8% (154 of 418) in the final 6 months of the intervention. No change was seen in balancing measures. The largest reduction in antibiotic prescribing was seen after implementation of PDSA 6 in which 14 high prescribers were identified and targeted for individualised reviews of encounters of patients with AUB with an antimicrobial steward.
conclusionsOperational implementation of successful stewardship interventions is challenging and differs from the traditional implementation study environment. As a nascent outpatient stewardship programme with limited resources and no additional intervention funding, we successfully reduced antibiotic prescribing from 64.6% to 36.8%, a reduction of 43% from baseline. The most success was seen with targeted education of high prescribers.
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