Communication Strategies to Improve Antibiotic Prescribing in Pediatric Urgent Care Centers

Authors

Amanda Nedved, From the Division of Urgent Care, Children's Mercy Kansas City; University of Missouri-Kansas City School of Medicine, Kansas City, MO.
Destani Bizune, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
Melody Fung, Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
Cindy M. Liu, Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
Sharon Tsay, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
Rana F. Hamdy
Amanda Montalbano, From the Division of Urgent Care, Children's Mercy Kansas City; University of Missouri-Kansas City School of Medicine, Kansas City, MO.

Document Type

Journal Article

Publication Date

5-18-2023

Journal

Pediatric emergency care

DOI

10.1097/PEC.0000000000002977

Abstract

OBJECTIVE: Urgent care (UC) clinicians frequently prescribe inappropriate antibiotics for upper respiratory illnesses. In a national survey, pediatric UC clinicians reported family expectations as a primary driver for prescribing inappropriate antibiotics. Communication strategies effectively reduce unnecessary antibiotics while increasing family satisfaction. We aimed to reduce inappropriate prescribing practices in otitis media with effusion (OME), acute otitis media (AOM), and pharyngitis in pediatric UC clinics by a relative 20% within 6 months using evidence-based communication strategies. METHODS: We recruited participants via e-mails, newsletters, and Webinars from pediatric and UC national societies. We defined antibiotic-prescribing appropriateness based on consensus guidelines. Family advisors and UC pediatricians developed script templates based on an evidence-based strategy. Participants submitted data electronically. We reported data using line graphs and shared deidentified data during monthly Webinars. We used χ2 tests to evaluate change in appropriateness at the beginning and end of the study period. RESULTS: The 104 participants from 14 institutions submitted 1183 encounters for analysis in the intervention cycles. Using a strict definition of inappropriateness, overall inappropriate antibiotic prescriptions for all diagnoses trended downward from 26.4% to 16.6% (P = 0.13). Inappropriate prescriptions trended upward in OME from 30.8% to 46.7% (P = 0.34) with clinicians' increased use of "watch and wait" for this diagnosis. Inappropriate prescribing for AOM and pharyngitis improved from 38.6% to 26.5% (P = 0.03) and 14.5% to 8.8% (P = 0.44), respectively. CONCLUSIONS: Using templates to standardize communication with caregivers, a national collaborative decreased inappropriate antibiotic prescriptions for AOM and had downward trend in inappropriate antibiotic prescriptions for pharyngitis. Clinicians increased the inappropriate use of "watch and wait" antibiotics for OME. Future studies should evaluate barriers to the appropriate use of delayed antibiotic prescriptions.

APA Citation

Nedved, Amanda; Bizune, Destani; Fung, Melody; Liu, Cindy M.; Tsay, Sharon; Hamdy, Rana F.; and Montalbano, Amanda, "Communication Strategies to Improve Antibiotic Prescribing in Pediatric Urgent Care Centers" (2023). GW Authored Works. Paper 2888.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2888

Department

Environmental and Occupational Health