Researchers at Vanderbilt University Medical Center have been awarded a five-year, $4.1 million grant from the National Institutes of Health to assess antibiotic prescriptions and antimicrobial stewardship in unplanned care spaces across Vanderbilt Health, including emergency rooms, retail clinics and walk-in clinics.
Antibiotic prescriptions, particularly those that are not necessary to treat infections, may contribute to antimicrobial resistance — a global health threat caused by microbes adapting to and reducing the effectiveness of antibiotics. The practice of antimicrobial stewardship seeks to combat this issue by promoting optimal use, dosage and duration of antibiotics.
The study, led by Michael Ward, MD, PhD, MBA, professor of Emergency Medicine and Biomedical Informatics, and Milner Staub, MD, MPH, assistant professor of Medicine, will compare usual antimicrobial stewardship practice with an advanced stewardship intervention bundle.
Adapted from the Care, Review, Assessment and Feedback Tool (CRAFT) bundle, the study will examine antibiotic prescriptions for acute upper respiratory tract infections (URIs) in a randomized clinical trial spanning up to 31 of Vanderbilt Health’s unplanned care spaces, which see an estimated 90,000 annual visits for acute URIs.
CRAFT was previously used to provide automated feedback on patient outcomes and clinical prescribing processes in urgent outpatient care settings as part of a Department of Veterans Affairs-funded grant originally developed with Michael Matheny, MD, MS, MPH, and focused on prescribing of antibiotics for URIs and nonsteroidal anti-inflammatory drugs, such as ibuprofen.
Now, the adapted tool, known as the CRAFT bundle In Acute Respiratory infections (CRAFT-IAR), will be used to study URIs including sinusitis, which accounts for approximately 40% of all outpatient antibiotic prescribing, contributing to the high rates of antibiotic-associated adverse events and the global threat of antimicrobial resistance.
“We’re excited to leverage the success of CRAFT to create an innovative bundle that includes education, clinician outreach and nonfinancial incentives to help us examine methods of reducing unnecessary antibiotic prescriptions for viral URIs,” said Ward, vice chair for Research in the Division of Emergency Medicine Research. “CRAFT-IAR includes electronic clinical decision support, alerting clinicians when alternatives to antibiotics may be more effective, which we believe will prove invaluable for finding avenues to treat illness other than unnecessary antibiotic prescriptions.”
The researchers aim to engage clinics, assess readiness for change and understand workflows in unplanned care spaces, as well as adapt the CRAFT bundle for each of those clinical settings.
Currently, an estimated 23%–51% of all outpatient antibiotic prescriptions for URIs are unnecessary. According to Ward, the researchers hypothesize that implementation of the CRAFT bundle will reduce potentially inappropriate antibiotic prescribing by at least 10%.
This study is supported by NIH grant R01AI187244.
