ICCs Successfully Reduce Antibiotic Use for Viral Illnesses

May 27, 2021 | 3 min. to read

An initiative by the Northwestern Medicine Immediate Care Center quality committee effected a 38% reduction in antibiotic prescribing for viral illnesses in immediate care centers (ICCs) across the system. That meant 6,459 fewer patients received antibiotics for viral illnesses by the end of fiscal year 2020.

The initiative involved a number of interventions, such as sharing comparative antibiotic prescription rates and reviewing them with individual physicians and APPs, distributing patient education pamphlets and using commitment posters from the Centers for Disease Control and Prevention (CDC) in each exam room. The use of the commitment posters outlines a proactive commitment to only prescribing antibiotics when they are necessary, and were developed in part by one of NM’s experts in antibiotic use, Jeffrey Linder, MD, who participated in the research group that first developed, implemented and tested them. The initiative also incorporated the use of a presentation from Dr. Linder which included an internally-developed video showcasing physician and patient interaction for physician and APP education.
 
Appropriate use of antibiotics in healthcare settings such as ICCs is proven to have multiple benefits. The main reason to reduce inappropriate antibiotic prescribing in ambulatory settings is to decrease adverse drug events for individual patients. Also, it decreases future care seeking for self-limited conditions, like the common cold. Furthermore, it improves individual patient outcomes, reduces the overall burden of antibiotic resistance, and reduces healthcare expenses. According to the CDC, outpatient settings are accountable for an estimated 80%-90% of human antibiotic use. Additionally, at least 30% of the antibiotics used in outpatient settings are unnecessary and account for more than 60% of antibiotic costs. Recognizing the opportunity for improvement, the NM Immediate Care Center quality committee led a successful initiative to reduce antibiotic prescribing for viral illnesses across the healthcare system from FY19 to FY20.

The challenge of the inappropriate use of antibiotics is particularly magnified in ICC settings. The Ambulatory Antimicrobial Stewardship Subcommittee of the System Antimicrobial Stewardship Committee found that NM ICCs were prescribing antibiotics for upper respiratory infection, pharyngitis with negative strep results, acute bronchitis and influenza at the rate of 34% in FY19. To improve these practices, a number of interventions were put into place.

An initial survey administered to physicians and advanced practice providers (APPs) found the main reason antibiotics were prescribed for viral illnesses was fear of patient dissatisfaction. Following this finding, data analysis of both clinicians’ antibiotic prescription rate and patient satisfaction was completed and shared, which uncovered no correlation.

Next, the quality committee shared regional-level comparative data for antibiotics prescription with clinicians and leadership through multiple regional and quality committee meetings. A quality measure summary report was developed using Enterprise Data Warehouse, which provided each individual clinician’s antibiotics prescription rate and compared it with the overall practice and regional rate. This gave regional leadership the opportunity to review the report with individual physicians and APPs periodically to discuss potential barriers and opportunities for improvement.

The committee also implemented the use of CDC commitment posters and patient education pamphlets. After all of these interventions were implemented, the overall rate of antibiotic prescribing was reduced to 21% at the end of FY20, a 38% reduction. Despite the challenges faced during the pandemic, ICC physicians and APPs continue to champion antibiotic stewardship, and the prescription rate continues to trend downward for FY21.

“Ensuring patients only receive antibiotics for appropriate diagnoses is key to avoiding adverse drug events and combating antibiotic resistance,” says Dharmesh Patel, NMG clinical quality leader supporting ICCs and antibiotic stewardship in the ambulatory setting.

“This initiative proves that together we can employ effective antibiotic-use programs to improve patient care and even possibly save lives,” says Lubna Madani, MD, North Region ICC medical director and lead physician for the ICC quality committee.
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For more information about NM ICC locations and services, visit the Northwestern Medicine Immediate Care Centers page on nm.org.