Evaluation of a pharmacist's impact on antimicrobial prescribing in an urgent care center

Abstract

AbstractIntroductionThe urgent care (UC) setting is an opportunity for pharmacists to promote antimicrobial stewardship (AS).ObjectivesThe primary objective is to determine compliance with antibiotic prescribing recommendations for the treatment of urinary tract infections (UTI), skin and soft tissue infections (SSTI), upper respiratory tract infections (URI), and lower respiratory tract infections (LRTI) before, during, and after the presence of an AS pharmacist in an UC.MethodsSingle‐center, retrospective, observational, pre‐ (December 10, 2018‐January 6, 2019), intervention (January 7, 2019‐February 3, 2019), and post‐ (February 4, 2019‐March 3, 2019) study. All nonpregnant, adult patients with a chief complaint consistent with UTI, SSTI, URI, or LRTI were included. Patients transferred to another facility, not seen by a provider, presented for a follow‐up visit, with multiple sites of infection, or treated for a bite, wound, or surgical site infection were excluded. Compliance was a composite end point of guideline adherent antibiotic prescribing, empiric selection, duration, and/or dosage. Secondary outcomes included composite outcome components and subgroup analysis of disease states. Logistic regression was performed to evaluate the intervention and other predictors of compliance.ResultsA total of 1930 patients were screened with 439 440, and 430 patients included in the pre‐, intervention, and post‐groups. Demographics were similar between groups, except for age (P = .001) and influenza diagnoses (P < .001). Likelihood of receiving guideline compliant therapy at pre‐intervention (57%), intervention (69%), and post‐intervention (73%) showed substantial improvement (P < .001). Controlling for background variables, participants were almost two times more likely to receive guideline compliant therapy at intervention than at pre‐intervention (odds ratio [OR] = 1.96, P < .001).ConclusionsAn AS pharmacist's presence in an UC significantly increased compliance with antibiotic prescribing recommendations. The largest impact was in reducing antibiotic treatment of viral infections and optimizing antibiotic dosing.