NEW YORK (June 7, 2018) – Physicians are open to receiving information on their antibiotic prescribing patterns, but have specific preference for receiving that information, according to results from a study published today in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America. Anticipating physicians' preferences for feedback on antimicrobial use (AU) could help optimize impact of antibiotic stewardship programs and improve the use of antibiotics.
"Antimicrobial use feedback is an important component of antibiotic stewardship initiatives that can improve the use of these drugs," said Tara Lines, PharmD, infectious disease pharmacy resident at Vanderbilt University Medical Center, and lead author of the study. "Understanding and anticipating the best way to communicate with providers can help drive change by ensuring providers are reached effectively."
The study reports responses to a 20-question survey from 211 inpatient providers at Vanderbilt University Hospital in various specialties. The survey included demographic questions, preferred feedback methods, barriers and comparison metrics, and a hypothetical patient hospitalization scenario assigning provider responsibility for antibiotic use. The clinical scenario became more complex with the number of consulting teams involved in the care of the patient and included transitions of care.
The findings demonstrate clear preferences from providers across specialties that can be used to ensure clinicians are more receptive to AU feedback:
- The vast majority (89 percent) of respondents preferred their own institutions determining provider use attribution as opposed to external personnel.
- Most wanted to be compared to other providers within their service (64 percent) with feedback provided on a quarterly basis (69 percent) via email (73 percent).
- Surprisingly, the study found that providers agreed upon attribution of antimicrobial use early on in a hospital stay scenario but disagreed once care became more complex, with some teams deferring and others accepting responsibility.
- Providers generally shared concern about quantitative feedback accounting for complexity of clinical care, severity of illness, and accuracy.
- Overall, 51 percent of providers anticipated changing practice based on AU feedback.
"Data can help drive change, however in order to implement meaningful change, we must overcome barriers and use this data to improve the use of antibiotics," said Lines. "As current national reporting utilizes unit-based and facility-wide data, local antimicrobial stewardship programs will play a crucial role in examining provider- or service level data to identify and act on stewardship opportunities and to increase the acceptability of these programs."
Limitations of the study include a low response rate; however findings are similar to past research regarding antimicrobial use within acute care hospitals. Additionally, the generalizability of these results may be limited as physicians in infectious diseases and critical care had the highest completion rates, which may have created a response bias toward more engaged providers.
The authors note that since antimicrobial stewardship is a shared responsibility across the healthcare continuum through various roles including house staff, physician assistants, nurse practitioners, pharmacists, nurses, and many others, future studies looking at all team members are needed.
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Tara H. Lines, PharmD; Whitney J. Nesbitt, PharmD, BCPS; George E. Nelson, MD. Driving antimicrobial use improvement: attitudes of providers of adult hospital care on optimal attribution and feedback. Web (June 7, 2018).
About ICHE
Published through a partnership between the Society for Healthcare Epidemiology of America and Cambridge University Press, Infection Control & Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. ICHE is ranked 19th out of 83 Infectious Disease Journals in the latest Web of Knowledge Journal Citation Reports from Thomson Reuters.
The Society for Healthcare Epidemiology of America (SHEA) is a professional society representing more than 2,000 physicians and other healthcare professionals around the world who possess expertise and passion for healthcare epidemiology, infection prevention, and antimicrobial stewardship. The society's work improves public health by establishing infection-prevention measures and supporting antibiotic stewardship among healthcare providers, hospitals, and health systems. This is accomplished by leading research studies, translating research into clinical practice, developing evidence-based policies, optimizing antibiotic stewardship, and advancing the field of healthcare epidemiology. SHEA and its members strive to improve patient outcomes and create a safer, healthier future for all. Visit SHEA online at http://www.shea-online.org, http://www.facebook.com/SHEApreventingHAIs and @SHEA_Epi.
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http://dx.doi.org/10.1017/ice.2018.113
