Patients who are unnecessarily exposed to antibiotics are at risk for serious adverse events with no clinical benefit, according to the Centers for Disease Control and Prevention (CDC). Antibiotic misuse also has contributed to the growing problem of antibiotic resistance, which has become one of the most serious and growing threats to public health. The CDC estimates that more than two million people are infected with antibiotic-resistant organisms each year, resulting in about 23,000 deaths. The federal agency recognizes there is no single template for a program to optimize antibiotic prescribing in U.S. health systems because the size and types of care they provide require flexibility in implementation.
The Atlantic Quality Innovation Network, the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for New York, South Carolina and Washington, D.C., found that providers were not lacking awareness about the need to reduce antibiotic use. What they needed to kick their antibiotic stewardship efforts into high gear, rather, was data and fresh ideas to implement a program.
“We’ve seen trending reports showing the use of Quinolone antibiotics—which the FDA has said should be reserved for situations in which no other option is available—be reduced from as high as 25 percent of antibiotics prescribed to as low as 10 percent among recruited practices.”
Many of the QIN-QIO’s 307 recruited outpatient practices in New York previously had been contacted by insurance companies inquiring about the overuse of prescriptions but had not been presented with hard data for multiple antibiotics and infections to help create an effective antibiotic stewardship program. This was where the Atlantic QIN stepped in. “We brought in data and new approaches, which is something they had not seen before,” said Teresa Lubowski, Pharm. D, BS, Pharmacist – Quality Improvement for the Atlantic QIN.
Initial 2015 data in New York showed that up to 43 percent of Medicare beneficiaries received at least one oral antibiotic. To engage providers, the QIN-QIO shared a heat map detailing antibiotic use in different counties of the state. Medicare antibiotic prescribing baseline reports gave providers a starting point, and success subsequently was measured with follow-up reports showing their trends over time.
Advisory panel members and site subject matter experts collaborated with the Atlantic QIN to develop resources to target improvement opportunities identified in baseline prescribing reports. This collaboration led to the creation of numerous resources that were shared with all the recruited providers. The Atlantic QIN developed a number of hard copy educational resources and guidelines, as well as educational videos, including “How to Read and Interpret an Antibiogram,” “Top 3 Myths About Penicillin Allergy,” “Duration of Antibiotic Therapy ‘Shorter is Better,’” and a patient video discussing antibiotic stewardship, which is intended to be shown in waiting rooms.
While official data for 2018 are still coming in, Lubowski, who has essentially become an additional member of the recruited provider stewardship teams, has seen numbers moving in the right direction. Having providers follow guidelines from the CDC’s Core Elements of Outpatient Antibiotic Stewardship, the New York State Department of Health Adult Treatment Recommendations and the U.S. Food & Drug Administration has helped reduce antibiotic use.
“We’ve seen trending reports showing the use of Quinolone antibiotics—which the FDA has said should be reserved for situations in which no other option is available—be reduced from as high as 25 percent of antibiotics prescribed to as low as 10 percent among recruited practices,” Lubowski said.