Abstract Corresponding Author Matthew Peworchik MD, Department of Pediatrics, Division of Infectious Diseases, Vanderbilt matthew.j.peworchik@vumc.org Funding This work was supported by an investigator-initiated QI grant through Pfizer. Conflict(s) of Interest Matthew Peworchik: no conflicts, Ritu Banerjee, no conflicts, Sophie Katz receives grant funding from Pfizer, serves as a consultant for Optum and a contractor for Merck. Background Antibiotic prescribing is highest in rural areas. This study implemented and evaluated bundled outpatient AS interventions using tele-stewardship (AS via telecommunication with clinicians) in rural pediatric primary care clinics (PCCs) and emergency departments (EDs) affiliated with VUMC. Methods The bundle includes (1) patient/guardian educational materials, (2) antibiotic use commitment posters (3) provider education through quarterly teaching pearls and app-based microlearning modules (QuizTime), and (4) quarterly audit/feedback with peer comparison on guideline-concordant antibiotic use via tele-meeting and email. Participants are pediatric prescribers (physician, physician assistant, nurse practitioner). We compared antibiotic prescription data for children 18 years collected during baseline (P1) prior to the implementation of the bundle (Jan 2022–Dec 2022) to post-implementation (P2; Jan 2023-Dec 2024). The primary outcome is percent (%) of encounters with an antibiotic prescription. Secondary outcomes include (1) % of encounters with guideline-concordant antibiotic choice for otitis media (AOM), group A streptococcal (GAS) pharyngitis, sinusitis, UTI, and community-acquired pneumonia (CAP); (2) % of encounters with 5-day antibiotic duration for AOM, sinusitis, and CAP; and (3) % of encounters with rapid GAS testing. Significance was determined by interrupted time series design with regression discontinuity analysis. Results There were 106 651 PC encounters and 40 739 ED encounters among 20 PC prescribers and 38 ED prescribers in the study period. Results are summarized in table 1, showing percentage point change from P1 to P2. Results varied by site, with some showing improvements in some outcomes but not others. Conclusion Bundled implementation strategies using tele-AS led to less overall and more guideline-concordant antibiotic use in rural EDs and PCCs. Frequency of rapid GAS testing decreased significantly, suggesting tele-AS is valuable for both antimicrobial and diagnostic stewardship.
Peworchik et al. (Mon,) studied this question.