Antibiotic Stewardship in Retail Health Care: Keep Up the Good Work!

Resistance has already occurred in an “antibiotic of last resort,” colistin, making it clear that all health care providers need to be careful when prescribing antiinfectives. Around the world, health care groups and policy makers are scrambling to implement reasonable, effective measures so that treatment is available when patients need it.

The journalHealthcarehighlights antibiotic stewardship efforts in the retail health setting with an article that describes CVS’s standardized approach to this concern, demonstrating that retail health care providers are leaders in antibiotic stewardship.

Half of MinuteClinic’s visits are for acute health problems, and the most common diagnoses are sinusitis, pharyngitis, or bronchitis. MinuteClinic integrates antibiotic stewardship into all of its guidelines, and updates its electronic medical record system regularly. Clinic leaders train staff and review 100% of charts for guideline adherence. Once the practice has been adopted, they audit 10% of records regularly.

They use several mechanisms to educate providers, including direct feedback, training, peer review, and interactive skill stations that emphasize patient conversation starters.

For antibiotic stewardship, skill stations remind retail health care providers to discuss numerous points with patients seeking antibiotics unnecessarily, including:

· reminding patients that antibiotics do not treat pain, and

· raising patients’ awareness of potential antibiotic-related problems (gastrointestinal disturbance,Clostridium difficilesuperinfection, and development of methicillin-resistantStaphylococcus aureus).

MinuteClinic’s efforts have been successful, and the study indicates that its retail health care providers provide exceptional care for bronchitis, pharyngitis, and urinary tract infections: 71.9% of MinuteClinic visits met or exceeded HEDIS quality benchmarks in 2014. Among ambulatory provider office visits, only roughly half met or exceeded HEDIS guidelines. Other studies demonstrate that antibiotic stewardship is practiced in most retail health settings.

MinuteClinic managers have identified some unacceptable downstream outcomes, such as patients who do not improve and see a different provider, and those who simply seek antibiotics elsewhere. They are focusing on improving explicit communication about what to do if patients do not improve, and helping their providers communicate guidelines to patients better. They have also found that ongoing provider education is critical to maintain adherence to guidelines.

Clinical managers recognize that 100% adherence to guidelines is impossible. In some patients, retail health care providers need to use their best clinical judgment.

Reference

Polinski JM, Harmon SL, Henderson KJ, Barker T, Sussman A, Gagliano NJ. Antibiotic stewardship in the retail clinic setting: Implementation in 1100 clinics nationwide.Healthc(Amst). 2017 Jul 4. pii: S2213-0764(16)30210-X. doi: 10.1016/j.hjdsi.2017.06.007. [Epub ahead of print]