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Evaluation of antibiotic prescribing in emergency departments and urgent care centers across the Veterans’ Health Administration

Published online by Cambridge University Press:  14 December 2020

James L. Lowery III ,
Bruce Alexander ,
Rajeshwari Nair ,
Brett H. Heintz  and
Daniel J. Livorsi Open the ORCID record for Daniel J. Livorsi [Opens in a new window]
James L. Lowery III
Affiliation:
Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
Bruce Alexander
Affiliation:
Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
Rajeshwari Nair
Affiliation:
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Brett H. Heintz
Affiliation:
Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
Daniel J. Livorsi*
Affiliation:
Iowa City Veterans Affairs Health Care System, Iowa City, Iowa Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
*
Author for correspondence: Daniel Livorsi, E-mail: [email protected]
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Abstract

Objective:

Assessments of antibiotic prescribing in ambulatory care have largely focused on viral acute respiratory infections (ARIs). It is unclear whether antibiotic prescribing for bacterial ARIs should also be a target for antibiotic stewardship efforts. In this study, we evaluated antibiotic prescribing for viral and potentially bacterial ARIs in patients seen at emergency departments (EDs) and urgent care centers (UCCs).

Design:

This retrospective cohort included all ED and UCC visits by patients who were not hospitalized and were seen during weekday, daytime hours during 2016–2018 in the Veterans Health Administration (VHA). Guideline concordance was evaluated for viral ARIs and for 3 potentially bacterial ARIs: acute exacerbation of COPD, pneumonia, and sinusitis.

Results:

There were 3,182,926 patient visits across 129 sites: 80.7% in EDs and 19.3% in UCCs. Mean patient age was 60.2 years, 89.4% were male, and 65.6% were white. Antibiotics were prescribed during 608,289 (19.1%) visits, including 42.7% with an inappropriate indication. For potentially bacterial ARIs, guideline-concordant management varied across clinicians (median, 36.2%; IQR, 26.0–52.7) and sites (median, 38.2%; IQR, 31.7–49.4). For viral ARIs, guideline-concordant management also varied across clinicians (median, 46.2%; IQR, 24.1–68.6) and sites (median, 40.0%; IQR, 30.4–59.3). At the clinician and site levels, we detected weak correlations between guideline-concordant management for viral ARIs and potentially bacterial ARIs: clinicians (r = 0.35; P = .0001) and sites (r = 0.44; P < .0001).

Conclusions:

Our findings suggest that, across EDs and UCCs within VHA, there are major opportunities to improve management of both viral and potentially bacterial ARIs. Some clinicians and sites are more frequently adhering to ARI guideline recommendations on antibiotic use.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 6 , June 2021 , pp. 694 - 701
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Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION: This work was presented at the Iowa Pharmacy Association’s Innovation and Research Forum conducted virtually in June 2020.

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