Addressing antibiotic resistance

Saturday, July 01, 2017 12:28 PM
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Clinicians agree that antibiotic resistance is a public health crisis. Yet for those who care for patients in outpatient settings – such as physician offices, urgent care clinics, emergency departments and pharmacies – many aren’t sure what they can do to make a difference. A new Telligen antibiotic stewardship initiative tailored to outpatient health care providers offers a stepwise approach to antibiotic stewardship to help prevent clinicians and staff members from feeling overwhelmed.

Antibiotic stewardship is a coordinated plan that promotes appropriate antibiotic use to help reduce microbial resistance and improve patient outcomes. Telligen works with health care providers throughout the state as Colorado’s Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for the Centers for Medicare and Medicaid Services (federal CMS). The organization’s new outpatient antibiotic stewardship initiative is helping clinicians, practices and clinics adopt the Centers for Disease Control and Prevention (CDC) Core Elements of Outpatient Antibiotic Stewardship with no-cost consulting services and technical assistance.

Colorado clinicians have until July 31 to sign up for the project, which will help participating clinicians incorporate the CDC core elements into their practices by the end of 2018. Here’s an outline of the CDC core elements and some common-sense examples to show how you or your practice can get started.

Commitment: Demonstrate dedication and accountability to optimize antibiotic prescribing

Telligen QIN-QIO Medical Director Christine LaRocca, MD, cites research that shows how simply displaying commitment letters in examination rooms can decrease inappropriate antibiotic prescribing for acute respiratory infections. As part of Telligen’s no-cost services, practices and clinics that partner with Telligen receive an antibiotic stewardship “start-up kit” of commitment posters, patient educational posters, brochures and an adult treatment recommendation resource. “These kits allow your practice or clinic to meet three out of the four CDC core elements immediately,” LaRocca says.

Action: Implement at least one policy or practice to improve antibiotic prescribing

The use of evidence-based diagnostic criteria and treatment recommendations can help improve prescribing practices. Clinicians may recognize opportunities for improvement for conditions such as bronchitis, pharyngitis and sinusitis.

LaRocca also emphasizes that reducing antibiotic underuse, overuse and misuse should be approached as “a team sport – from appointment-setting and reception to triage, diagnosis, discharge and pharmacy.” Research has shown that unnecessary antibiotic prescribing for respiratory illnesses rises as the day progresses, demonstrating the effects of “decision fatigue” among stressed clinicians. Telligen staff offer training using evidence-based systems like Team Strategies and Tools to Support Performance and Patient Safety (TeamSTEPPS®) to improve communication and collaboration among your health care team.

Tracking and reporting: Monitor at least one aspect of antibiotic prescribing

Tracking and reporting allows clinicians to assess progress. “You could start by tracking appropriate use of a single antibiotic, such as levofloxacin, for which the FDA added an updated warning in 2016,” LaRocca says. For those practices with an electronic health record (EHR), this information can often be generated with existing EHR reports, or Telligen can help your staff get started with this process. Other practices have considered tracking antibiotic use for a defined duration, such as the traditional flu season of Oct. 1 to March 1. “There’s no requirement for participants to share their practice data with Telligen,” LaRocca says. “Clinicians need only keep us informed in their journey to complete all four CDC core elements.”

Education and expertise: Provide resources to clinicians and patients on evidence-based antibiotic prescribing

Patient and clinician education cannot be overlooked, as real and perceived patient demand is an important factor in antibiotic overuse. From patient education materials to suggested scripts to help prepare for talks with patients and families about appropriate antibiotic use, Telligen can offer tools and resources that will help you maintain patient satisfaction while practicing good antibiotic stewardship.

A win-win: The MIPS connection

With the May release of Merit-Based Incentive Payment System (MIPS) clinician participation letters, outpatient clinicians who care for Medicare Part B patients may be looking for ways to successfully participate this year. The federal CMS has included implementation of an antibiotic stewardship program as one of the MIPS improvement activities. So activities that you or your practices take on in 2017 to help decrease the spread of antibiotic resistance can also help you avoid negative payment adjustments of up to 4 percent in 2019.

“Antibiotic stewardship is important to patient safety,” LaRocca says, “and we know that no action during the 2017 MIPS performance year means a 4-percent negative payment adjustment in 2019 for health care providers participating in MIPS. If done right, implementing antibiotic stewardship in 2017 counts as a MIPS improvement activity and will help you avoid a downward payment adjustment in 2019.”

“The Telligen program supports an urgent need recognized by the federal CMS and the CDC among community health care providers. Clinicians who join us by July 31 can get no-cost help from Telligen to implement antibiotic stewardship in outpatient settings. It’s a win-win for patients and providers.”

Telligen is accepting applications for its outpatient antibiotic stewardship initiative from Colorado physician offices, emergency rooms, urgent care centers, rural health clinics, federally qualified health centers and pharmacies through July 31, 2017. To learn more or to sign on, visit https://telligenqinqio.com/our-work/antibiotic-stewardship/ or contact Andrea Campbell at andrea.campbell@area-d.hcqis.org or Christine LaRocca at christine.larocca@area-d.hcqis.org.

 

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