Category: Student Posters
Christine Tabulov– PharmD Candidate, University of Florida College of Pharmacy, Palm Harbor, Florida
Poster Type: Evaluative Study
Poster Category: Drug Information/Drug Use Evaluation
Purpose: According to The National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB), the goal for appropriate antibiotic prescribing in ambulatory clinics is 85 percent by the year 2020. The purpose of this study was to identify appropriate versus inappropriate prescribing patterns using national guidelines and local antibiograms at the student-run Equal Access Clinic Network (EACN) in Gainesville, Florida. This study was performed to ensure the clinic is prescribing anti-infectives to meet the standard set by CARB.
Methods: A retrospective chart review was performed for this study using the electronic health record, Practice Fusion. Patients seen at two different clinic sites at EACN between January 1, 2015 to December 31, 2016 that were prescribed any anti-infective (prescription-only or over the counter) including antibiotics, antifungals, and antivirals were included for analysis. Patients with prescriptions written for dental-associated infections and prescriptions without specified diagnoses documented in Practice Fusion were excluded. The primary outcome was to determine if anti-infective prescribing was deemed appropriate or inappropriate using national guidelines and local antibiograms compared to the 85 percent appropriate benchmark set by CARB. The secondary outcome was to determine what infectious diseases needed improvement in anti-infective prescribing using national guidelines and local antibiograms compared to the CARB goal of 85 percent appropriate. The study was exempted from institutional review board approval.
Results: The total number of anti-infective prescriptions written at the two clinic sites for the study period was 237 and 189 prescriptions met inclusion criteria. The results for the primary outcome revealed that 107 prescriptions (56.614 percent) were appropriate for diagnosis. The total number of inappropriate prescriptions prescribed for diagnosis was 82 (43.386 percent). For the secondary outcome, the appropriate prescribing percentages were broken down into five groups of infectious diseases including sexually transmitted infections (82.258 percent), skin and soft tissue infections (67.857 percent), other infections (60.000 percent), respiratory infections (44.898 percent), and urinary tract infections (10.340 percent). A chi squared test was performed with Bonferroni correction on the five different disease states (n equals 5, p equals 0.01). The two statistically significant groups were sexually transmitted infections (p less than 0.01) for appropriate prescribing and urinary tract infections (p less than 0.01) for inappropriate prescribing.
Conclusion: Overall, the two EACN clinic sites did not meet the goal of 85 percent appropriate anti-infective prescribing. There was a statistically significant rate of inappropriate urinary tract infection prescribing and appropriate sexually transmitted infection prescribing. However, none of the disease states met the goal of 85 percent appropriate anti-infective prescribing. These recommendations were made without the use of local antibiogram and were restricted by the most cost-effective options. The results of the study suggest the need for an antimicrobial stewardship program in which student-pharmacists may play a large role to help improve prescribing patterns.