Improving Primary Care Providers’ Attitude and Participation in Antimicrobial Stewardship

Abstract

Purpose: Purpose of this quality improvement (QI) project was to increase provider knowledge, self-efficacy in antibiotic prescribing, and stewardship in outpatient clinic settings.Background: Antibiotics can alleviate suffering and provide life-saving effects when used appropriately. Antibiotic resistance accompanied exponential increase in use and overprescribing antibiotics, resulting in over 2,000,000 resistant infections, and leading to 23,000 preventable deaths in United States annually. Additionally, preventable morbidity/mortality, antibiotic resistance contributes to significant financial burdens, particularly within outpatient settings. Approximately 60% of antibiotic expenditure occurs within outpatient settings; 20% of pediatric and 10% of adult visits resulted in inappropriate antibiotic prescriptions. According to Centers for Disease Control and Prevention (CDC), 30% or more antibiotic prescriptions within outpatient settings are unnecessary. Antibiotic stewardship programs aimed at educating primary care providers emerged to moderate antibiotic prescriptions, including dosage, route, duration to mitigate negative effects such as antibiotic resistance, and infection recurrence. Nurse practitioners provide 69% of primary care, and serve as potent champions for antibiotic stewardship, advocacy, and education for patients within primary care settings. Methods: Posttest survey was administered to primary care providers in outpatient settings. Willing providers attended a 20-minute post-intervention session based on CDC’s Antibiotic Training Series. Immediately following education session, participants completed posttest survey aimed at assessing acquired knowledge, attitudes, self-efficacy, and confidence in antibiotic prescribing. Posttest survey also included general ratings and attitudes of participants regarding education sessions. Findings: Four out of five invited providers participated in 20-minute educational session. Participating providers rated overall knowledge, attitudes, and intent to change prescribing habits highly, indicating importance of outpatient antimicrobial stewardship. Results will be utilized to guide future PDSA cycles of this QI project. Conclusion: This QI project demonstrates effectiveness of outpatient antimicrobial stewardship, continuing education on antibiotics on providers’ overall knowledge, attitudes, and intent to utilize evidence-based practice. Scope is small, this QI project intended to be specific, rather than generalizable. Further investigation and analysis of prescribing rates for specific conditions may be warranted to help potentiate effects of QI project and help influence future PDSA cycles. Lastly, additional educational intervention may be necessary to further disseminate impact of outpatient antimicrobial stewardship.