Despite advances in VA acute care hospitals, antibiotic stewardship, defined as any activity that optimizes antibiotic use or stops unnecessary use, is largely absent in VA long-term care facilities (LTCF; known as community living centers or CLCs). This proposal seeks to develop and implement an educational intervention targeting CLC pharmacists to improve antibiotic use for urinary tract infections (UTI), the largest contributor to antibiotic use in LTCFs. This work will lead to improvements in the care and safety of our Veterans residing in CLCs and our nation's population at large.
The aims of this work are 1) to describe UTI related antibiotic use and inappropriate antibiotic use among VA CLCs nationally and identify independent predictors of inappropriate antibiotic use, 2) to develop an educational intervention targeting CLC pharmacists to reduce inappropriate treatment of UTIs and pilot test the intervention in two VA CLCs, and 3) to evaluate the effectiveness of the educational intervention on UTI related antibiotic use and the frequency of inappropriate antibiotic use.
This work will utilize an overarching work systems approach to achieve the proposed aims, using both qualitative and quantitative methodologies. For Aim 1, retrospective analysis of large national VA databases will be used to describe antibiotic use and inappropriate antibiotic use, and independent predictors of inappropriate antibiotic use will be identified through assessment of all relevant factors in the work system. For Aim 2, an educational program for pharmacists will be developed and implemented at two CLCs to improve antibiotic use for UTIs. Feedback on the intervention and the impact on the existing work system will be obtained through qualitative interviews. For Aim 3, the effectiveness of the educational intervention will be evaluated using a quasi-experimental methodology.
Not yet available.
The proposed research is significant, because it is expected to result in an intervention that can be disseminated broadly to effectively improve antibiotic use, and ultimately improve Veteran safety through reduction of antibiotic resistant infections in CLCs nationally.
- Appaneal HJ, Caffrey AR, Lopes VV, Dosa DM, Shireman TI, LaPlante KL. Frequency and Predictors of Suboptimal Prescribing Among a Cohort of Older Male Residents with Urinary Tract Infections. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2021 Nov 2; 73(9):e2763-e2772.
- Appaneal HJ, Shireman TI, Lopes VV, Mor V, Dosa DM, LaPlante KL, Caffrey AR. Poor clinical outcomes associated with suboptimal antibiotic treatment among older long-term care facility residents with urinary tract infection: a retrospective cohort study. BMC geriatrics. 2021 Jul 23; 21(1):436.
- Appaneal HJ, Caffrey AR, Lopes VV, Crnich CJ, Dosa DM, LaPlante KL. National trends in the treatment of urinary tract infections among Veterans' Affairs Community Living Center residents. Infection control and hospital epidemiology. 2019 Oct 1; 40(10):1087-1093.
- Appaneal HJ, Luther MK, Timbrook TT, LaPlante KL, Dosa DM. Facilitators and Barriers to Antibiotic Stewardship: A Qualitative Study of Pharmacists' Perspectives. Hospital pharmacy. 2019 Aug 1; 54(4):250-258.
Infectious Diseases, Health Systems