The effect of a multimodal stewardship approach on antibiotic prescribing for outpatients with acute respiratory tract infections: Order set implementation and education

• Published in: JAACP : Journal of the American College of Clinical Pharmacy 2020-11, Vol.3 (7), p.1319-1325
• Main Authors: Peterson, Eric, Fergus, Jonathan, Yost, Christine, Qu, Lihua, Chittick, Paul
• Format: Article
• Language: English
• Subjects: beta‐lactams; evidence‐based medicine; infectious disease; primary care
• ISSN: 2574-9870; 2574-9870
• DOI: 10.1002/jac5.1303

Introduction Although antimicrobial stewardship initiatives in the outpatient setting have been increasing, the effect of order set implementation on antibiotic prescribing for acute respiratory tract infections (ARTI) has not been fully established. Objective This study's objective was to determine the impact of order sets and education on antibiotic prescribing for ARTI in the outpatient setting. Methods This was a quasi‐experimental research study conducted from January 2015 through December 2016. The study was conducted at an adult ambulatory care clinic associated with a tertiary care medical center. Order sets and prescriber education were created and implemented to aid in the diagnosis and treatment of ARTI. The primary end point was a composite of antibiotic prescribing frequency for ARTI. Secondary objectives included antibiotic appropriateness, patients requiring follow‐up clinic visits, and development of Clostridioides difficile infection. Results A total of 3292 patients were included in the study. Unspecified respiratory tract infection (RTI) was the most common diagnosis. Antibiotic prescribing decreased from 33% to 24% in the postintervention period (relative risk 0.74 [0.64‐0.85], P =