204. Impact of Education and Data Feedback Interventions on Outpatient Prescribing for Urinary Tract Infections

Abstract

Background. Urinary tract infections (UTIs) are the most common outpatient indication for antibiotics and an excellent target for outpatient antimicrobial stewardship (AS) interventions. Tis study evaluated the impact of education and data feedback on outpatient UTI diagnosis and prescribing. Methods. A clinic-specifc antibiogram, diagnosis and treatment guideline, and educational session were provided at one urgent care (UC) and one primary care (PC) clinic in Durham, NC in August and November of 2017. Educators reviewed the appropriate diagnosis, treatment, and duration of therapy for UTIs, including avoidance of treatment for asymptomatic bacteriuria and choice of first-line agents with lower collateral damage. Adult encounters with a UTI diagnosis code from November 2016 to November 2017 and from August 2016 to August 2017 were included in the pre-intervention cohort for UC and PC, respectively. The postintervention cohort included encounters following education intervention in April 2018. Summary data of UTI diagnoses and guideline concordant prescriptions were fed back to clinics February 2018. The primary endpoint was proportion of first- or second-line antibiotic choice for UTI according to clinic-specifc guidelines. Pre- and postintervention phase and trend changes were assessed by an interrupted time series approach. Results. Data were collected on 2,660 and 1,016 UTI encounters at UC and PC, respectively. Guideline concordant prescribing increased at UC from 29% at baseline to 47% in the 5 months afer the education and at PC from 54% at baseline to 62% in the 8 months afer the education (Figures 1 and 2). The mean number of UTI diagnoses per month decreased at UC from 142 at baseline to 102 and at PC from 32 at baseline to 25 afer the education. Conclusion. Clinicians increased guideline concordant prescribing and reduced diagnosis rates for UTIs. AS is effective at improving guideline-directed diagnosis and management of UTIs in outpatient settings.