Adopting Urinary Tract Infection Guidelines to Promote Antibiotic Stewardship in the Time of Telehealth Medicine.

IF 0.2 Q4 NURSING Journal of Doctoral Nursing Practice Pub Date : 2023-06-27 DOI:10.1891/JDNP-2022-0026
Ragan Johnson, Thomas N Groff, Vanessa M Kirkwood, Katie L Richardson, Julie A Thompson
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Abstract

Background: The most modifiable risk factor contributing to antibiotic resistance is the inappropriate prescription of antibiotics. Urinary tract infections (UTIs) are a common outpatient infection in the United States, with increasing antimicrobial resistance to uropathogens. As empiric UTI treatment is often appropriate, telemedicine offers an opportunity to enhance practice by adopting current clinical practice guidelines. Objective: The project aims to improve appropriate first-line antibiotic choice and decrease urinalysis and urine culture orders in the telehealth management of uncomplicated UTIs. Methods: Chart reviews of women aged 18-65 years diagnosed with an uncomplicated UTI and/or symptoms during a telehealth primary care visit were conducted for a period of 30 days prior to and following a provider educational intervention. Results: Improvement (37.5%-62.1%, p = .133), though not significant, of appropriate first-line antibiotics prescribing postintervention was achieved. There was a minimal (3%) improvement in the appropriate urine labs ordered. Conclusion: Following the intervention, there was not a statistically significant practice change, albeit somewhat of an improvement in the ordering of first-line antibiotics. Adopting evidence-based practice in telehealth could provide an opportunity to improve antibiotic stewardship. Providers are potentially better engaged through the presence of champions, in-person education sessions, and the availability of streamlined algorithms.

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采用尿路感染指南在远程医疗时代促进抗生素管理。
背景:导致抗生素耐药的最可改变的危险因素是抗生素处方不当。尿路感染(uti)在美国是一种常见的门诊感染,对尿路病原体的抗微生物药物耐药性不断增加。由于经验性尿路感染治疗通常是合适的,远程医疗通过采用当前的临床实践指南提供了一个加强实践的机会。目的:提高非复杂性尿路感染远程医疗管理中一线抗生素的合理选择,减少尿分析和尿培养订单。方法:在提供者教育干预之前和之后的30天内,对在远程卫生初级保健访问期间诊断为无并发症尿路感染和/或症状的18-65岁妇女进行图表回顾。结果:干预后一线抗生素处方改善(37.5% ~ 62.1%,p = 0.133),但不显著。在适当的尿检中有最小(3%)的改善。结论:干预后,虽然一线抗生素的使用有所改善,但没有统计学上显著的实践变化。在远程保健中采用循证实践可为改进抗生素管理提供机会。通过冠军的出现、面对面的教育会议和简化算法的可用性,提供者可能会更好地参与其中。
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CiteScore
0.60
自引率
0.00%
发文量
45
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