Antimicrobial tele-stewardship strategies and their application to the rural outpatient setting

Objective: To review the variety of antimicrobial tele-stewardship strategies and their applicability to the rural outpatient context. Design: Narrative review of antimicrobial tele-stewardship activities and their potential adaptability to rural outpatient settings. Results: Few studies evaluate implementation and outcomes of antimicrobial stewardship in rural settings. In this review we summarize the variety of methods that have been used in tele-stewardship implementation research, and how each can be adapted to the rural outpatient setting, including: audit and feedback, peer comparison, provider education, guideline creation, consultation with infectious disease providers, and electronic medical record nudges. Conclusions: Tele-stewardship activities are likely to benefit outpatient rural settings, though further implementation research is needed.