Effect of a pharmacist-managed program of pneumococcal and influenza immunization on vaccination rates among adult inpatients.
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Adult↗
Biomedical subjects
Meera Kelley
Publications and source records attributed to Meera Kelley.
Using hospital antibiogram data to assess regional pneumococcal resistance to antibiotics.
Antimicrobial resistance to penicillin and macrolides in Streptococcus pneumoniae has increased in the United States over the past decade. Considerable geographic variation in susceptibility necessitates regional resistance tracking. Traditional active surveillance is labor intensive and costly. We collected antibiogram reports from North Carolina hospitals and assessed pneumococcal susceptibility to multiple agents from 1996 through 2000. Susceptibility in North Carolina was consistently lower than the national average. Aggregating antibiogram data is a feasible and timely method of monitoring regional susceptibility patterns and may also prove beneficial in measuring the effects of interventions to decrease antimicrobial resistance.
Anti-Bacterial Agents↗
Antibiotic prescriptions associated with outpatient visits for acute upper respiratory tract infections among adult Medicaid recipients in North Carolina.
BACKGROUND: North Carolina and the southeastern United States have the highest antimicrobial resistance rates for common respiratory tract pathogens in the nation. The excessive use of antibiotics for common outpatient infections is a major contributing factor in the emergence of antibiotic resistant bacteria. OBJECTIVE: To estimate the prevalence of oral antibiotic treatment for acute, nonbacterial respiratory tract infections among adult Medicaid recipients in North Carolina, and to describe a pilot project aimed at reducing the prevalence of oral antibiotic treatment among this population. METHODS: Using administrative claims data, we identified 24,137 Medicaid recipients, aged 18 to 64 years, who made at least one outpatient physician visit for acute nasopharyngitis (ICD-9, 460.x), acute pharyngitis (462.x), acute upper respiratory infection (465.9), acute bronchitis (466.0), or influenza (487.1) between October 1, 2000, and March 29, 2001. We excluded adults with chronic bronchitis (ICD-9, 491.x), emphysema (492.x), asthma (493.x), or chronic obstructive pulmonary disease (496.x). Pharmacy claims data were used to identify oral antibiotic treatment that occurred within 5 days of the outpatient visit. RESULTS: Overall, 63% (n = 15,189) of Medicaid recipients who made at least one outpatient visit during the observation period for one of the study conditions had a prescription filled for an oral antibiotic within 5 days. Residence in a rural county (64% vs. urban, 61%, p < 0.01) and in the eastern region of the state (65% vs. western region, 59%, p < 0.01) was associated with receipt of an antibiotic. Compared with the other principal study diagnoses, patients with acute bronchitis (44% of all outpatient visits) were 2.88 (95% CI = 2.72, 3.05) times more likely to receive oral antibiotic treatment after multivariate adjustment. SUMMARY: The prevalence of oral antibiotic treatment among adult Medicaid beneficiaries diagnosed with nonspecific upper respiratory infections, colds, pharyngitis, bronchitis, and influenza is high and varies significantly across patient demographics and geography. Interventions to reduce antibiotic prescribing are needed to reduce the progression of antimicrobial resistance.
Administration, Oral↗
Feasibility of a primary care intervention to decrease oral antibiotics for acute upper respiratory tract infections: A pilot study.
BACKGROUND: Antimicrobial resistance in common respiratory tract pathogens is a growing public health threat, especially in the southeastern United States. The excessive use of antibiotics for common infections is a major contributing factor in the emergence of antibiotic resistance. We report results from a multi-site outpatient pilot project in North Carolina to reduce antibiotic prescriptions for acute nonbacterial upper respiratory tract infections (URIs). METHODS: Primary care practices were provided education and symptom therapy kits for patients with URIs, as an alternative to antibiotics, in a project to reduce the overuse of antimicrobial therapy The feasibility of this approach was evaluated with interviews and surveys. A methodology for claims-based evaluation of intervention efficacy in reduction of antibiotics use was developed as part of this project. RESULTS: Of eight contacted practices, four agreed to participate and three participated fully. Physicians reported that symptom therapy kits were useful for patients with URIs and resulted in a meaningful change in antibiotic prescribing behaviors. A claims-based approach is a feasible and promising method to evaluate efficacy in subsequent post-pilot large-scale implementations. LIMITATIONS: Due to the small number of outpatient practices and the lack of controls in this pilot study, the efficacy of the intervention in reducing antibiotic use could not be determined. CONCLUSIONS: Education combined with symptom therapy kits as an alternative to oral antibiotics is a feasible intervention that warrants additional studies to evaluate the efficacy of this approach in the reduction of antibiotic use for URIs.
Administration, Oral↗