Original Research
Sunday, October 13, 2024
12:45 PM–02:15 PM
Abstract
Introduction:
Previous literature indicates that discharge antibiotic prescriptions are infrequently monitored by antimicrobial stewardship programs and are often guideline-discordant. Leveraging clinical pharmacists’ expertise may optimize discharge antibiotic prescribing, benefitting individual patients and improving public health outcomes.
Research Question or Hypothesis:
Does pharmacist review and intervention lead to improved discharge antibiotic prescribing?
Study Design:
This is a multi-center, quasi-experimental study of an intervention in which a pharmacist reviews, documents and communicates discharge antibiotic recommendations to the primary inpatient medical team, aiming to have a significant public health impact.
Methods:
Included patients were admitted to a participating center between 1/1/2020-5/1/2024, treated for an index infection while inpatient and prescribed oral antibiotics for discharge. Patients were compared prior to intervention implementation (pre-intervention group) to those after intervention implementation (post-intervention group). The primary outcome was the overall discharge antibiotic appropriateness, defined as having an appropriate indication, duration, agent and dose. Clinical outcomes, including adverse drug events, 30-day hospital or emergency department readmission and 30-day recurrence were compared.
Results:
There were 125 included patients from four community hospitals; 76 pre-intervention and 49 post-intervention. Patients were a median of 69.0 years old (IQR 60.0-80.5), 48% male and 83.2% non-Hispanic Caucasian. The predominant index infection sources were urinary tract (56.0%) and pneumonia (34.4%); 70.4% had a positive culture. Pharmacists made 48 unique interventions within the post-intervention group; 53.1% were accepted by the primary medical team. Among the post-intervention group, discharge antibiotic prescriptions were overall more appropriate (42.9% vs. 23.7%, p = 0.024), particularly in terms of agent selection (88.4% vs. 64.5% p = 0.005). There was no difference in adverse events, 30-day infection recurrence or 30-hospital or emergency department readmission.
Conclusion:
A pharmacist-led intervention was associated with improved discharge antibiotic prescribing. Future work should focus on efforts to increase the acceptance and implementation of these antimicrobial stewardship interventions as they could have broader impact on public health.
Presenting Author
Kaylee Caniff PharmDWayne State University
Authors
Alexandra Angel PharmD
Memorial Healthcare System
Brenda Brennan MSPH
Michigan Department of Health and Human Services
Anne Haddad MPH
Michigan Department of Health and Human Services
Dana Holger PharmD
Nova Southeastern University
Jade Motley PharmD
Memorial Healthcare System
Nathan Richards PharmD
Munson Medical Center
Elizabeth Rodriguez PharmD
McLaren Greater Lansing Hospital
Michael Rybak Pharm.D., M.P.H., Ph.D.
Wayne State University
Marco Scipione PharmD
Detroit Receiving Hospital
Nathan Steffke PharmD
Memorial Healthcare System
Nicholas Torney PharmD
Munson Medical Center
Michael Veve PharmD, MPH
Wayne State University