Implementation of an Outpatient Antimicrobial Stewardship Program to Reduce Fluoroquinolone Overprescribing at a Veterans Affairs Academic Medical Center
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Background: Fluoroquinolones are often overprescribed in outpatient settings, and antibiotic stewardship programs designed to prevent overuse are not well described. The primary purpose of this study was to evaluate the change in overall and appropriate fluoroquinolone prescribing rates by primary care providers at a Veterans Affairs Medical Center before and after implementation of an audit and feedback intervention. Methods: After a medical chart audit to assess appropriateness of fluoroquinolone prescriptions to outpatient medical teams, feedback was given to providers regarding monthly fluoroquinolone utilization and prescribing patterns along with monthly didactic lectures on appropriate fluoroquinolone use. Study objectives were assessed before and after the intervention time period using segmented regression time series analysis including a non-intervention comparator clinic. Results: In the non-intervention clinics, rates of fluoroquinolone orders increased from 3.9±5.2 orders per week per 1,000 patient visits in the pre-intervention time period to 5.8±6.7 orders per week per 1,000 patient visits in the post-intervention time periods. In the intervention clinics, rates of fluoroquinolone orders decreased from 9.4±5.8 orders per week per 1,000 patient visits in the pre-intervention time period to 6.9±6.6 orders per week per 1,000 patient visits in the post-intervention time periods. Using segmented regression analysis controlling for change in prescribing rates in the non-intervention clinics and changes in the rate of prescribing over time, the intervention was associated with a 3.1±0.99 decrease in fluoroquinolone orders per week per 1,000 patient visits (p=0.0019). The percentage of orders deemed appropriate increased from increased from 50±31% in the pre-intervention time period to 66±53% in the post-intervention time period (p=0.06). Conclusion: An audit and feedback intervention in ambulatory care clinics was able to reduce the rate of fluoroquinolone orders and increase the percent of orders deemed appropriate.