Antibiotic Stewardship in Consumer-Driven Healthcare Sectors
Antibiotic use is a major driver of antibiotic resistance. Reducing inappropriate antibiotic use in all settings, including human medicine and food animal production is crucial to preserving the utility of these life-saving drugs. In the U.S., most antibiotics are dispensed in outpatient settings.
The main consumer-driven healthcare sectors in the U.S. include telemedicine, retail clinics, and urgent care.
Telemedicine
ARAC is collaborating with a leading telemedicine company, Doctor on Demand, in order to understand the drivers of inappropriate antibiotic prescribing and to evaluate potential interventions in this rapidly growing field of medicine. Our research includes novel provider-level interventions that aim to reduce inappropriate prescribing of antibiotics, quantifying the effectiveness of communication strategies, and analyses of factors that contribute to inappropriate prescribing in the telemedicine setting.
Urgent Care
Urgent care is the largest consumer-driven healthcare sector that now accounts for 80 to 100 million patient visits each year. Urgent care centers offer walk-in care for non-emergency conditions. There are about 7,500 urgent care centers are operating in the U.S today. Urgent care sees a disproportionate share of patients seeking convenient and affordable treatment of acute, infectious disease-related symptoms, such as cough and sore throat.
As a growing outpatient sector, urgent care has a unique opportunity to significantly improve outpatient antibiotic prescribing, enhance patient care quality, and combat antibiotic resistance. Yet, a number of factors hinder the initiation, continual improvement, and evaluation of antibiotic stewardship activities in this setting. As a result, ARAC is working with key stakeholders in the urgent care sector, together with academic and governmental partners, to address these challenges to improve antibiotic stewardship.
ARAC Forms Partnership with Urgent Care Association to Address Antibiotic Use in Rapidly Growing Urgent Care Sector
In September 2016, ARAC and the Urgent Care Association formed a partnership to make the urgent care industry a leader in antibiotic stewardship by reducing inappropriate antibiotic use in this outpatient setting — action that could help slow the growing threat of antibiotic resistance.
ARAC and UCA are combining their respective expertise to improve patient and clinician understanding of appropriate antibiotic use. Throughout the partnership, ARAC and UCA will develop patient education programs, implement training and education programs for both clinical and non-clinical staff, identify the most effective clinical decision support tools, collect in-depth data on antibiotic prescribing, implement evidence-based antibiotic stewardship practices and conduct research.
ARAC Research Activities
As part of our urgent care work, ARAC is working with UCA and other stakeholders on several research projects focused on finding the best ways to communicate with urgent care patients that improves their understanding of when antibiotics are needed while also ensuring patients feel satisfied with their visits.
- “Shifting Patient Expectations When Antibiotics Are Not Needed: Which Messages Are Most Effective?”
- Poster presented at the 9th Annual International Antimicrobial Stewardship Conference in June 2018 by Dr. Rana Hamdy, Stewardship Advisor for ARAC and pediatric infectious diseases physician at Children’s National Health System (CNHS).
ARAC Convenes the First Urgent Care Antibiotic Stewardship Summit
In July 2018, ARAC convened the first-ever Urgent Care Antibiotic Stewardship Summit in Atlanta. The Summit was co-hosted by the Centers for Disease Control and Prevention (CDC) and the Urgent Care Association (UCA) and attended by leading urgent care organizations in the U.S., insurance companies, electronic health record companies and public health experts. The goal of the meeting was to further develop a multi-stakeholder commitment and an industry-wide action plan on antibiotic stewardship. Funding for the Urgent Care Antibiotic Stewardship Summit was provided by ARAC.
ARAC Co-Hosts Antibiotic Stewardship Symposium
As a follow-up to the first-ever Urgent Care Antibiotic Stewardship Summit in July 2018, the Urgent Care Association and ARAC co-hosted an Antibiotic Stewardship Symposium held October 15, 2018 in Houston, TX. The symposium convened urgent care leaders and decision makers for a roundtable discussion on the importance of antibiotic stewardship in the outpatient setting and evidence-based practices that contribute to the responsible prescribing of antibiotics. The group agreed it would spend the next several months developing antibiotic stewardship initiatives that urgent care organizations could champion over the next few years. The initiatives will be announced at UCA's annual conference in April 2019.
Resources on Antibiotic Stewardship in Outpatient Settings
CDC Core Elements of Outpatient Antibiotic Stewardship
The Core Elements of Outpatient Antibiotic Stewardship provides a framework for antibiotic stewardship for outpatient clinicians and facilities that routinely provide antibiotic treatment. This report augments existing guidance for other clinical settings.
Mitigate Antimicrobial Stewardship Toolkit
This guide is written for healthcare providers and administrators interested in designing quality improvement programs in antimicrobial stewardship. This guide outlines how facilities can implement individualized, effective, and practical antimicrobial stewardship programs in acute care (emergency department and urgent care) settings. It was published in April 2018.
How to Prescribe Fewer Unnecessary Antibiotics: Talking Points That Work with Patients and Their Families
Published by Katherine Fleming-Dutra, MD, Centers for Disease Control and Prevention, Rita Mangione-Smith, MD, University of Washington and Seattle Children's Research Institute and Lauri Hicks, DO, Centers for Disease Control and Prevention in American Family Physician August 2016.
Patient/Consumer Facing CDC Materials
- Chart: Virus or Bacteria: What’s Got You Sick? - Learn when antibiotics are and aren’t needed.
- Brochure: Antibiotics Aren’t Always the Answer - A 2-page trifold brochure with detailed information for patients. Print-only format in PDF.
- Symptom Relief for Viral Illnesses Prescription Pad - Prescription pads with information on symptom relief. Print-only format in PDF.
Antibiotics Aren’t Always the Answer by the CDC
Other Resources
- CDC's Be Antibiotics Aware (View the English and/or Spanish websites)
- Expert Spotlight Interview with Laurel Stoimenoff, CEO, Urgent Care Association
- UCA Position Statement on Improving Antibiotic Stewardship in Urgent Care
- Online Antibiotic Stewardship Education: Offered by UCA. Improve your subject matter knowledge and earn CME - discounted pricing for UCA members.
- CDC Antibiotic Stewardship Course: Doctors, nurse practitioners, physician assistants, certified health education specialists, nurses, pharmacists, and public health practitioners with a master’s degree in public health are eligible to receive up to eight hours of free CE for the entire course. (Download the flyer)