Title PagePediatrics
Antibiotic Decisions Lindsay H. Cameron, M.D., M.P.H.
Collaborators: Shelley Kumar, M.S., Terry Yen, M.D, Kasey Jackson, M.D., Zanaib Arif, Francisco DeGuzman Mentors: Satid Thammasitboon, M.D., Luis Ostrosky M.D., Deb Palazzi M.D.,M.Ed
Page 1
•Identify barriers to pediatric UC provider optimal
use of antibiotics for pediatric URIs
•Illustrate an asynchronous online course to
improve UC provider antibiotic decisions
Learning Objectives
Page 2
Page 3
Page 4
• Format: Asynchronous Online Course
Published Interventions
•Effect is lost post intervention
Gerber JS et. al JAMA 2013; 309:2345-52. Gerber JS et al. JAMA 2014;312:2569-70.
Page 6
Published Interventions
Offer reassurance
Suggest strategies for resolution
Timeline to reduce suffering
Action plan (← to clinic)
Szymczak JE, et al. JPIDS. 2018; 7(4):303-9. Mangione-Smith R, et al. Arch Pediatr Adolesc Med. 2001; 155:800-6. Cabral C, et al. Ann Fam Med. 2016;14:141-147. Cabral C, et al. Pat Educ Couns. 2014; 95:248-53.
Page 7
• Target Population: TCH Urgent Care Providers (n~120)
•Asynchronous Online Curriculum
•Parent Perspectives
•Incentives: CME credit & MOC Part 2
Intervention
Methods: Course Structure
Methods: Knowledge Assessment
Participant Flow Chart
0
20
40
60
80
100
120
72.00%
65.01%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
p=0.115
Sinusitis Pre-test Post-test % difference p-value
Presentation 65.7% 100.0% 34.3% 0.0005
Antibiotic Choice 94.3% 100.0% 5.7% 0.1573
Acute Otitis Media
Antibiotic Choice 91.2% 100.0% 8.8% 0.0833
Indications for Treatment
Antibiotic Choice 34.3% 77.1% 42.9% <.0001
Diagnosis 85.3% 97.1% 11.8% 0.2188
Management of Nonadherence 57.1% 94.3% 37.1% 0.0002
Page 14
Parent Perspectives
Page 15
Page 16
Parent Perspectives Results
•UC provider constraints:
66% believed most parents seek UC for antibiotic
•After exposure to content:
Page 17
Participant Motivation to Increase Use of Relationship Centered Communication # # of responses %
Introduction to encounter Identify expectations 18 51
Establish priorities 9 26
Enhanced patient-provider
Prioritize parent concerns 14 40
Expression of Empathy
Encounter Closure
Page 18
Course Evaluation (n=20)
Knowledge retention Significant retention, n=15 (75%) Moderate retention, n=5 (25%) Some retention, n=0 No retention, n=0
Satisfaction
Course content Completely satisfied, n=17 (85%) Satisfied, n=3 (15%) Neutral, n=0 Not satisfied, n=0
Time investment Completely satisfied, n=17 (85%) Satisfied, n=3 (15%) Neutral, n=0 Not satisfied, n=0
Usefulness Completely satisfied, n=18 (90%) Satisfied, n=2 (10%) Neutral, n = 0 Not satisfied, n = 0
Page 19
Improvement in Practice (n=20)
Diagnosis and treatment Yes, n = 18 (90%) No, n = 0 I don’t know, n = 2 (10%)
Quality care Yes, n =19 (85%) No, n = 0 I don’t know, n=1 (15%)
Antibiotic prescribing Yes, n=20 (100%) No, n=0
Page 20
Analysis: Antibiotic Use
•↑use of amoxicillin-clavulanate for pediatric
sinusitis
AOM
PCN non-allergic patients
Page 22
•Qlick sense limitations:
Tracks antibiotic dispenses
• Watchful waiting
No allergy data linked to chart
Depends on coding (many codes used)**
Page 23
Antibiotic Dispenses for URIs, by Campus, 2017-2019
UC 2017 2018 2019 Total
AOM 19087 32528 50773 102388
Pharyngitis 18513 30028 45570 94111
Sinusitis 4576 8681 10093 23350
Total 42176 71237 106436 219849
TCPA 2017 2018 2019
CTC health plan 2017 2018 2019
AOM 512 676 818 2,006
Pharyngitis 211 256 187 654
Sinusitis 364 288 178 830
Total 1087 1220 1183 3,490
Page 24
xxx00.#####.ppt 9/4/2020 7:58:40 AM Pediatrics Pediatrics
Participant vs. Non-participant Antibiotic Use Pre and Post Exposure to the Online Course Pre score (mean %) Post score (mean %) t-test*
AOM Participants (n = 35) amoxicillin/Augmentin use 85.80% 87.80% 0.937 non amoxicillin/Augmetin use 14.20% 12.20% Non participants (n = 57) amoxicillin/Augmentin use 82.30% 84.30% non amoxicillin/Augmetin use 17.70% 15.70%
Sinusitis Participants (n = 23) Augmentin use 54.60% 67.90% 0.708 non Augmentin use 45.40% 32.10% Non participants (n= 38) Augmentin use 44.80% 50.80% non Augmentin use 55.20% 49.20%
Pharyngitis Participants (n= 29) PCN use 86.50% 89.30% 0.807 non-PCN use 13.40% 10.70% Non participants (n = 55) PCN use 83.70% 87.30% non-PCN use 16.30% 12.70%
Page 25
xxx00.#####.ppt 9/4/2020 7:58:40 AM Pediatrics Pediatrics
Participant vs. Non-participant Antibiotic Use Pre and Post Exposure to the Online Course Pre score (mean %) Post score (mean %) t-test*
AOM Participants (n = 35) amoxicillin/Augmentin use 85.80% 87.80% 0.937 non amoxicillin/Augmetin use 14.20% 12.20% Non participants (n = 57) amoxicillin/Augmentin use 82.30% 84.30% non amoxicillin/Augmetin use 17.70% 15.70%
Sinusitis Participants (n = 23) Augmentin use 54.60% 67.90% 0.708 non Augmentin use 45.40% 32.10% Non participants (n= 38) Augmentin use 44.80% 50.80% non Augmentin use 55.20% 49.20%
Pharyngitis Participants (n= 29) PCN use 86.50% 89.30% 0.807 non-PCN use 13.40% 10.70% Non participants (n = 55) PCN use 83.70% 87.30% non-PCN use 16.30% 12.70%
Page 26
•Asynchronous Online Education
Conclusions