1847. Impact of Antimicrobial Stewardship Commitment Posters on Antibiotic Prescribing for Upper Respiratory Tract Infections in a Rural Outpatient Setting

Abstract

BackgroundThe Centers for Disease Control and Prevention advocates for the display of commitment posters in outpatient clinics for healthcare providers to pledge to only prescribe antibiotics when a bacterial infection is suspected. However, their impact on antibiotic prescribing in the outpatient setting has largely been part of multi-faceted interventions in academic medical centers or urban cities rather than in rural settings.MethodsThe objective of this study was to determine the impact of commitment posters as a single-intervention in rural outpatient clinics on antibiotic prescribing for upper respiratory tract infections (URIs). This was a quasi-experimental study performed at The Guthrie Clinic, a network of outpatient clinics located in rural New York and Pennsylvania. Commitment posters were displayed in examination and waiting rooms of outpatient clinics (n = 19) between April and June 2017 (intervention period). Patients with a URI visit diagnosis code during the period of July 1, 2016–December 31, 2016 (pre-intervention) and July 1, 2017–December 31, 2017 (post-intervention) were included. Demographic, provider, clinic, and antibiotic prescription data were collected.ResultsA total of 4,422 and 3,830 URI cases were diagnosed, and antibiotics were prescribed for 2,406 and 1,969 cases in the pre- and post-intervention periods, respectively. Fewer antibiotics were prescribed for URI cases in the post-intervention period compared with pre-intervention (54.6% vs. 51.6%, P = 0.013). The most commonly prescribed antibiotics in both cohorts were amoxicillin, amoxicillin–clavulanate, and azithromycin. Male gender (P = 0.0045), older age (P < 0.001), and patients who were seen by a provider other than their primary care provider (P = 0.001), were associated with a higher proportion of antibiotics prescribed per URI diagnosis. There was no statistically significant difference in antibiotics prescribed for patients with and without certain comorbidities such as diabetes or chronic obstructive pulmonary disease.ConclusionAntibiotic stewardship commitment posters were associated with a decrease in the number of antibiotics prescribed for URIs in rural clinics and represent a low-hanging fruit intervention for outpatient antibiotic stewardship programs, particularly in rural settings.Disclosures All authors: No reported disclosures.