Pediatric Urgent Care Providers' Approach to Antibiotic Stewardship

Background Outpatient antibiotic prescribing for acute respiratory conditions is highest in urgent care settings; however, this has not been studied among pediatric urgent cares. The objective of this study was to evaluate pediatric urgent care providers' perceptions of antibiotic stewardship. Methods Members of the Society for Pediatric Urgent Care were recruited via email to participate in a quality improvement antibiotic stewardship project. A preimplementation survey was sent to participants via email in March 2019 to evaluate perceptions on antibiotic stewardship. Descriptive statistics were used to analyze the survey responses. Results A total of 156 providers completed the survey; 83% were board-certified pediatricians. Almost all (98%) indicated that antibiotic stewardship interventions are important for optimizing antibiotic use in urgent care. More than half (53%) indicated that their urgent care provided guidelines for prescribing antibiotics for acute respiratory tract infections. Treating patients with an underlying complex medical condition was the most common reason (21%) providers would deviate from guidelines. The most commonly cited barriers to appropriate prescribing for acute respiratory infections were patient expectations (93%), psychosocial barriers (40%), lack of clear evidence-based recommendations (15%), and lack of access to guidelines on prescribing (15%). Conclusions Parental expectation of receiving antibiotics was viewed as the most common barrier to appropriate prescribing. These findings should be used to target directed interventions such as shared decision making and communication training to support appropriate antibiotic prescribing in pediatric urgent care.

[1]  W. McIsaac,et al.  Barriers and facilitators to the uptake of an antimicrobial stewardship program in primary care: A qualitative study , 2020, PloS one.

[2]  Antibiotic resistance threats in the United States, 2019 , 2019 .

[3]  Shabnam Jain,et al.  Improving Bronchiolitis Care in Outpatient Settings Across a Health Care System. , 2019, Pediatric emergency care.

[4]  Daniel J. Shapiro,et al.  Antibiotic Prescribing for Children in United States Emergency Departments: 2009–2014 , 2019, Pediatrics.

[5]  C. Giaquinto,et al.  The Impact of Clinical Pathways on Antibiotic Prescribing for Acute Otitis Media and Pharyngitis in the Emergency Department , 2018, The Pediatric infectious disease journal.

[6]  A. Monto,et al.  Outpatient Antibiotic Prescribing for Acute Respiratory Infections During Influenza Seasons , 2018, JAMA network open.

[7]  A. Hersh,et al.  Variation in Antibiotic Prescribing among Emergency Departments, Urgent Care Centers, and Retail Health Clinics in the United States, 2014 , 2017, Open Forum Infectious Diseases.

[8]  M. Hall,et al.  Urgent Care and Emergency Department Visits in the Pediatric Medicaid Population , 2015, Pediatrics.

[9]  Jeffrey D. Robinson,et al.  Communication Practices and Antibiotic Use for Acute Respiratory Tract Infections in Children , 2015, The Annals of Family Medicine.

[10]  S. Solomon,et al.  Antibiotic resistance threats in the United States: stepping back from the brink. , 2014, American family physician.

[11]  P. Harris,et al.  Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support , 2009, J. Biomed. Informatics.

[12]  Paul Little,et al.  Importance of patient pressure and perceived pressure and perceived medical need for investigations, referral, and prescribing in primary care: nested observational study , 2004, BMJ : British Medical Journal.

[13]  M. Elliott,et al.  Why do physicians think parents expect antibiotics? What parents report vs what physicians believe. , 2003, The Journal of family practice.

[14]  M. Cabana,et al.  Why don't physicians follow clinical practice guidelines? A framework for improvement. , 1999, JAMA.