Adult Acute Sinusitis Antimicrobial Stewardship Program in a Primary Care Setting

BACKGROUND: Inappropriate antibiotic prescribing is a well-documented global health crisis (Centers for Disease Control, CDC, 2013). Antimicrobial stewardship (AS) is the purposeful selection of the correct drug, dose, route and duration of antimicrobial treatment to decrease microbial resistance, adverse drug effects and cost while improving patient outcomes (Dellit et al., 2007; CDC, 2016). Antimicrobial Stewardship Programs (ASP) are multidisciplinary programs designed to improve AS. PURPOSE: To describe baseline prescribing patterns and evaluate the effect of an antimicrobial stewardship program (ASP) for adult acute sinusitis on provider knowledge and antibiotic prescribing practice. among primary care providers in an internal medicine clinic in an academic medical center in Kentucky METHODS: In this pre/post-test quasi-experimental design study a baseline chart audit was conducted to determine baseline prescribing practices. An evidence based ASP was developed and implemented to assess pre/post provider knowledge as determined by changes survey scores after the education based ASP. Following the ASP, a focus group structured on the Health Belief Model was conducted to elicit perceived barriers to deliver guideline recommended care. RESULTS: The sample contained 22 patient chats for the baseline chart audit. The chart audits revealed that care was concordant the majority (59.1%) of the time, the lowest scoring component of the chart audit was timing (50%) and was significantly different between concordant and unconcordant care. Eleven providers completed the pretest and participated in the ASP and focus group 9 of the 11 providers completed the post-test 1 week after the ASP. Overall knowledge increased from after the ASP (M = 52.27, SD =26.11) vs. (M = 55.56, SD = 24.3). Concordant care was delivered in 59.1% of cases. Providers reported a desire for support in appropriate prescribing and in educating patients on appropriate antibiotic use. CONCLUSION: Care was concordant the majority (59.1%) of the time, and correct antibiotic selection occurred 100%. Key areas for improvement include waiting for long enough symptom duration … correct symptom duration. The ASP was feasible to implement and was well received by attendees. Future ASP sessions should include a multidisciplinary team, multiple sessions which include active participation, and communication skills. Future studies should identify specific provider, clinical and patient components that influence the effectiveness of outpatient stewardship programs