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Posted: January 15th, 2024
Assessing Provider Adherence to Guidelines for Antibiotic Stewardship
Antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients. Improving antibiotic prescribing and use is critical to effectively treat infections, protect patients from harms caused by unnecessary antibiotic use, and combat antibiotic resistance (CDC, 2023). However, many providers do not follow the best practices for antibiotic stewardship, such as making a diagnosis based on multiple data points, limiting empiric therapy to life-threatening situations, knowing the local resistance patterns, and selecting the optimal antibiotic regimens, routes of administration, and durations (WHO, n.d.; NICE, 2015).
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This blog post aims to assess the current state of provider adherence to guidelines for antibiotic stewardship in different settings and identify the barriers and facilitators for improving adherence. It also provides some recommendations for health care organizations, policy makers, and researchers to promote antibiotic stewardship and reduce the threat of antimicrobial resistance.
Current State of Provider Adherence to Guidelines for Antibiotic Stewardship
According to a recent report by the Agency for Healthcare Research and Quality (AHRQ), provider adherence to guidelines for antibiotic stewardship varies widely across different settings and types of infections (AHRQ, 2022). For example, in hospitals, adherence rates ranged from 38% to 95% for community-acquired pneumonia, from 22% to 100% for urinary tract infections, and from 18% to 100% for skin and soft tissue infections. In outpatient settings, adherence rates ranged from 14% to 100% for acute respiratory infections, from 36% to 100% for urinary tract infections, and from 0% to 100% for skin and soft tissue infections. In long-term care settings, adherence rates ranged from 0% to 100% for urinary tract infections and from 0% to 83% for skin and soft tissue infections.
The report also identified several factors that influenced provider adherence to guidelines for antibiotic stewardship, such as provider knowledge, attitudes, and beliefs; patient expectations and preferences; organizational culture and leadership; availability of resources and support; feedback and audit; education and training; and external incentives and regulations.
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Barriers and Facilitators for Improving Provider Adherence to Guidelines for Antibiotic Stewardship
Some of the common barriers that prevent providers from adhering to guidelines for antibiotic stewardship are:
- Lack of awareness or familiarity with the guidelines or their rationale
- Lack of agreement or trust in the guidelines or their sources
- Lack of confidence or competence in applying the guidelines or managing uncertainty
- Fear of missing a diagnosis or causing harm to patients
- Fear of losing patient satisfaction or facing medicolegal consequences
- Pressure from patients or peers to prescribe antibiotics
- Difficulty in accessing or interpreting diagnostic tests or resistance data
- Difficulty in communicating or coordinating with other providers or teams
- Lack of time or workload constraints
- Lack of feedback or recognition for appropriate prescribing
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Some of the common facilitators that enable providers to adhere to guidelines for antibiotic stewardship are:
- Awareness and understanding of the guidelines and their rationale
- Agreement and trust in the guidelines and their sources
- Confidence and competence in applying the guidelines or managing uncertainty
- Perception of benefit or harm reduction for patients
- Perception of patient satisfaction or medicolegal protection
- Support from patients or peers to avoid antibiotics
- Availability and accessibility of diagnostic tests or resistance data
- Availability and accessibility of communication or coordination tools with other providers or teams
- Availability and accessibility of time or workload management strategies
- Availability and accessibility of feedback or recognition for appropriate prescribing
Recommendations for Improving Provider Adherence to Guidelines for Antibiotic Stewardship
Based on the evidence and experience from various interventions and programs, some of the recommendations for improving provider adherence to guidelines for antibiotic stewardship are:
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- Develop and disseminate clear, concise, and evidence-based guidelines that are tailored to different settings and types of infections
- Provide education and training on the guidelines and their rationale, as well as on clinical reasoning and decision making skills
- Provide feedback and audit on prescribing patterns and outcomes, as well as on patient satisfaction and safety
- Provide support and resources for diagnostic testing, resistance surveillance, communication, coordination, time management, etc.
- Provide incentives and recognition for appropriate prescribing, such as financial rewards, public reporting, accreditation, etc.
- Provide regulation and accountability for inappropriate prescribing, such as sanctions, penalties, litigation, etc.
- Engage patients and the public in raising awareness and understanding of antibiotic stewardship and antimicrobial resistance, as well as in reducing demand and expectations for antibiotics
Conclusion
Antibiotic stewardship is a key strategy to optimize antibiotic use and combat antimicrobial resistance. However, provider adherence to guidelines for antibiotic stewardship is suboptimal in many settings and types of infections. There are multiple barriers and facilitators that influence provider adherence, which require multifaceted and tailored interventions and programs to address them. Health care organizations, policy makers, and researchers should work together to develop, implement, and evaluate effective and sustainable solutions to improve provider adherence to guidelines for antibiotic stewardship and ultimately improve patient outcomes and public health.
Works Cited
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AHRQ. (2022). Antibiotic Stewardship Toolkits. Retrieved from https://www.ahrq.gov/antibiotic-use/index.html
CDC. (2023). Core Elements of Antibiotic Stewardship. Retrieved from https://www.cdc.gov/antibiotic-use/core-elements/index.html
NICE. (2015). Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use. Retrieved from https://www.nice.org.uk/guidance/ng15
WHO. (n.d.). Introduction to antimicrobial stewardship and Principles of antimicrobial prescribing. Retrieved from https://cdn.who.int/media/docs/default-source/searo/essential-medicines/presentation-introduction-to-antimicrobial-stewardship-and-principles-of-antimicrobial-prescribing.pdf?sfvrsn=59bab377_1
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