The impact of a pharmacist-led intervention on discharge antibiotic prescribing

Document Type

Conference Proceeding

Publication Date

12-17-2024

Publication Title

J Am Coll Clin Pharm

Keywords

antibiotic agent, adult, adverse drug reaction, antimicrobial stewardship, Caucasian, clinical outcome, clinical pharmacist, community hospital, conference abstract, emergency ward, female, health outcome, hospital readmission, human, major clinical study, male, outpatient department, pharmacist, pharmacoeconomics, pneumonia, prescription, quasi experimental study, recurrent disease

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 and 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 postintervention 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.

Volume

7

Issue

12

First Page

1303

Last Page

1304

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