VUMC Group Partners With State of Tennessee to Tackle Antibiotic Overuse
Pilot Aims to Improve Antibiotic Prescribing
The Antimicrobial Stewardship Program at Monroe Carell Jr. Children’s Hospital at Vanderbilt is focused on countering a public health crisis: the emergence of antibiotic-resistant pathogens caused by overuse and misuse of antibiotics.
Sophie Katz, MD, Director of Outpatient Pediatric Antimicrobial Stewardship at Vanderbilt University Medical Center (VUMC), is at the forefront of new research and programming aimed at extending antimicrobial stewardship efforts to all outpatient settings across the VUMC network, including walk-in clinics, after-hours clinics, urgent care centers, primary care practices and retail clinics.
Recently, Dr. Katz and team have set sights on the broader community as well, thanks to an innovative pilot program in partnership with the Tennessee State Department of Health (TDH).
VUMC and the TDH are jointly conducting research to gauge the effectiveness of antimicrobial stewardship across different health care settings. Three organizations were selected for the pilot: a large pediatric practice in Green Hills, an urgent care clinic in Alcoa and a solo-physician practice in Columbia.
Antimicrobial stewardship involves education, training and process improvement to ensure appropriate antibiotic prescribing by clinicians and use by patients. Such programs focus on minimizing misdiagnoses and ensuring the right drug, dose and duration are deployed when an antibiotic is needed.
Practices participating in the pilot receive education and training via quarterly meetings with VUMC and the TDH. These meetings are used to review data and provide feedback on antibiotic prescribing performance, both at the practice level and individual provider level. Additionally, the pilot practices are developing new clinical practice guidelines to positively influence antibiotic prescribing.
“This is mission-critical work for our community,” said Dr. Katz. “This is a national issue that also hits very close to home.”
A Public Health Crisis
Antibiotic resistance is one of the nation’s greatest public health threats, leading to an estimated 2 million infections and 23,000 deaths per year in the United States.
In outpatient settings, where most antibiotics are prescribed, nearly one-third of prescriptions are unnecessary. Meanwhile, many others include inappropriate medication selection, dosing or duration. This crisis is particularly concerning for Tennessee, which has the 7th highest antibiotic prescribing rate in the country. Recent statistics show the state has a prescribing rate of 1,195 prescriptions per 1,000 total population.
The 18-month pilot launched in 2023 and concluded in June 2024. The three practices will continue to be observed for an additional six months to see if improvements made during the pilot are sustainable. Initial data suggests all practices in the pilot will be able to report success.
“For all practices in this study, we are seeing improvements in guideline-concordant antibiotic prescribing, with practices using antibiotics in accordance with established scientific evidence,” said Dr. Katz. “This reinforces something I believe deeply. Every practice can do this and be successful.”
PCORI Funding
Recently, Vanderbilt University Medical Center (VUMC) was awarded $1 million in funding from the Patient-Centered Outcomes Research Institute (PCORI) to expand the research done through the Outpatient Pediatric Antimicrobial Stewardship.
The PCORI-funded implementation project seeks to reduce antibiotic prescribing for acute respiratory tract infections by 5% overall, while also fostering use of narrow-spectrum antibiotics and shorter courses of treatment and reducing excess testing for strep throat infections.
The project will take place at several VHAN member clinics, including VUMC-affiliated outpatient pediatric primary care clinics, urgent care clinics (walk-in and pediatric after-hours clinics), retail health clinics (Vanderbilt clinics at Walgreens), emergency departments, and Heritage Medical Clinic. Across the 52 sites, the intervention will engage 376 front-line care delivery staff and will reach an estimated 103,000 patients.
Interventions will include evidence-based implementation strategies such as distributing patient/caregiver education handouts, offering provider education through lectures and app-based quizzes, and providing audit and feedback reports with peer comparison on antibiotic use, antibiotic duration and treatment failure rates.
3 Ideas for Creating an Antibiotic Stewardship Program
Dr. Katz is hopeful that VUMC can continue to extend its impact across Vanderbilt Health Affiliated Network and beyond. In the meantime, she has advice for practices who want to initiate their own stewardship programs:
- Examine your practice’s specific needs and performance. Dr. Katz suggests identifying deficiencies that would have the highest impact, such as reducing antibiotic prescriptions for upper respiratory infections.
- Look for educational opportunities through the lens of provider and patient. On the clinical side, with so much new and evolving information to keep up with, some providers may lean too heavily on past prescribing habits. On the patient side, many individuals pressure physicians to give them antibiotics because of past experiences and misconceived notions around antibiotic use. Dr. Katz believes it’s important to reset patient understanding of this issue as well.
- Revisit current protocols. A practice may want to test for strep throat to avoid treating false positives, or develop new clinical practice guidelines for treatment of ear infections to improve effectiveness and consistency across the practice.
“Most practices are spread thin, and it’s always hard to add one more thing to the plate,” said Dr. Katz. “But antibiotic stewardship is critically important work to be done, and it is manageable if you approach it properly. A little effort goes a long way.” To learn more about VUMC and VHAN’s resources for strengthening antibiotic stewardship, visit VHANHub.com/antibiotics.