ABSTRACT
Purpose/Objectives: The AHRQ Safety Program for Improving Antibiotic Use aimed to improve antibiotic use by engaging clinicians and staff to incorporate antibiotic stewardship principles into practice culture, communication, and decision making. We report on changes in visits and antibiotic prescribing among participating pediatric primary and urgent care ambulatory practices during the COVID-19 pandemic. Design/Methods: The Safety Program used webinars, audio presentations, educational tools, and office hours to engage clinician champions and staff leaders to: (a) establish antibiotic stewardship programs, (b) address attitudes and culture that pose challenges to judicious antibiotic prescribing, and (c) incorporate best practices for the management of common infections into their workflow using the Four Moments of Antibiotic Decision Making framework. Monthly data on total visits (in-person and virtual), acute respiratory infection (ARI) visits, and antibiotic prescribing were collected from all participating practices during the pre-intervention period (September 2019-November 2019) and during the Safety Program (December 2019-November 2020). Data from the beginning to the end of the Safety Program were compared using linear mixed models to account for random effects of participating sites and repeated measurements of outcomes within practices over time. Results: The 63 participating pediatric practices included 23 general pediatric clinics (37%) and 40 pediatric urgent care clinics (63%). 60 practices submitted complete data for analysis, including 1,040,810 visits. Visits/practice-month declined March-April 2020 but exceeded baseline by Safety Program end (Figure 1). Total antibiotic prescribing declined by 16 prescriptions/100 visits (95% CI: -18 to -14) from November 2019 and November 2020. ARI visits/practice-month similarly declined March-June 2020 after widespread recognition of the COVID-19 epidemic, and remained below baseline by Safety Program end (Figure 2). ARIrelated antibiotic prescriptions decreased by 16 prescriptions/100 ARI visits (95% CI: -20 to -12) from November 2019 to November 2020. Among antibiotic classes, the greatest change was in penicillins. Prescriptions for penicillins was reduced by 11 prescriptions/100 ARI visits (95% CI: -14 to -8). Conclusion/Discussion: During the COVID-19 pandemic, while visit rates gradually normalized, a national ambulatory Antibiotic Stewardship program was associated with declines in overall and ARI-related antibiotic prescribing.
ABSTRACT
Background: At the outbreak of the pandemic in Chicago, there were disruptions in daily life, communication and delivery of healthcare services. Our objective was to investigate mental well-being, lifestyle behaviors, self-management capacity and healthcare utilization during the early months of the COVID-19 pandemic among older adults with one or multiple chronic conditions. Methods: Telephone interviews were conducted as part of the ongoing COVID-19 & Chronic Conditions (C3) study between March and May 2020. Participants were recruited from local academic and safety net clinics and participated in existing research studies prepandemic. Self-report items assessed perceived stress due to coronavirus, self-management capacity and healthcare utilization. Validated measures assessed well-being, alcohol consumption, physical activity and self-efficacy. Results: The average age of participants (N=565) was 62.4, most were female (61.4%), and over half (n=310) were non-White or Latinx. One in five (20.7%) participants were stressed about the coronavirus most or all the time. Almost a quarter (22.3%) engaged in hazardous drinking and 79.7% reported insufficient physical activity. Nearly one in four participants (23.7%) avoided seeking medical care due to worry about COVID-19. In multivariable analyses, women reported more stress than men. Greater COVID-19 related stress and low health activation were associated with less physical activity, lower self-efficacy, greater difficulty managing health/medications and more avoidance of medical care. Conclusion: Consequences of COVID-19 on the mental wellbeing, lifestyle and ability of adults with chronic conditions to manage health were apparent in the initial months of the pandemic. As the C3 study is ongoing, it will be possible to examine pre- and postpandemic factors over time to understand the influence of the pandemic on the overall health trajectories of older adults.
ABSTRACT
The optimal time to initiate research on emergencies is before they occur. However, timely initiation of high quality research may launch during an emergency under the right conditions. These include an appropriate context, clarity in scientific aims, preexisting resources, strong operational and research structures that are facile, and good governance. Here, Nebraskan rapid research efforts early during the 2020 coronavirus disease pandemic, while participating in the firstuse of U.S. federal quarantine in 50 years, are described from these aspects, as the global experience with this severe emerging infection grew apace. The experience has lessons in purpose, structure, function, and performance of research in any emergency, when facing any threat.
ABSTRACT
Background. The AHRQ Safety Program for Improving Antibiotic Use aimed to improve antibiotic use by engaging clinicians and staff to incorporate antibiotic stewardship (AS) into practice culture, communication, and decision making. We report on changes in visits and antibiotic prescribing in AHRQ Safety Program ambulatory practices during the COVID-19 pandemic. Methods. The Safety Program used webinars, audio presentations, educational tools, and office hours to engage clinician champions and staff leaders to: (a) address attitudes and culture that pose challenges to judicious antibiotic prescribing and (b) incorporate best practices for the management of common infections into their workflow using the Four Moments of Antibiotic Decision Making framework. Total visits (in-person and virtual), acute respiratory infection (ARI) visits, and antibiotic prescribing data were collected. Using linear mixed models to account for random effects of participating practices and repeated measurements of outcomes within practices over time, data from the pre-intervention period (September-November 2019) and the Ambulatory Care Safety Program (December 2019-November 2020) were compared. Results. Of 467 practices enrolled, 389 (83%) completed the program, including 162 primary care practices (42%;23 [6%] pediatric), 160 urgent care practices (41%;40 [10%] pediatric), and 49 federally-supported practices (13%). 292 practices submitted complete data for analysis, including 6,590,485 visits. Visits/practice-month declined March-May 2020 but gradually returned to baseline by program end (Figure 1). Total antibiotic prescribing declined by 9 prescriptions/100 visits (95% CI: -10 to -8). ARI visits/practice-month declined significantly in March-May 2020, then increased but remained below baseline by program end (Figure 2). ARI-related antibiotic prescriptions decreased by 15/100 ARI visits by program end (95% CI: -17 to -12). The greatest reduction was in penicillin class prescriptions with a reduction of 7/100 ARI visits by program end (95% CI: -9 to -6). Conclusion. During the COVID-19 pandemic, a national ambulatory AS program was associated with declines in overall and ARI-related antibiotic prescribing.
ABSTRACT
Purpose/Background: Remote physician-patient encounters have emerged as a new standard during the COVID-19 pandemic. Multidisciplinary clinic (MDC) is known to be beneficial in the treatment of colorectal cancer patients, but telehealth adaptations of MDC have not yet been described. The objectives of this study were to transition in-person MDC to a telehealth MDC (tele-MDC) format and to assess early outcomes. Methods/Interventions: This single-institution pilot study began in April 2020 after restrictions due to the COVID-19 pandemic halted the in-person MDC. A tele-MDC was devised, in which patients with colon, rectal or anal cancers could participate in a clinic appointment with multiple specialists simultaneously using remote-access technology. The team consisted of representatives from surgery, medical and radiation oncology, radiology, and pathology. Each tele-MDC session began with a case conference, in which clinical data were reviewed and a preliminary clinical plan was proposed. Patients were then brought to the clinic where, with in-person guidance from the surgeon, they were introduced to the other specialists in the virtual platform, using both video and audio communication. Following a patient interview, the final comprehensive treatment plan was discussed with the patient and any family members in attendance. Outcomes were assessed with the patient and provider surveys, each comprised of 13 questions or fewer using a 5-point Likert scale (with higher scores indicating more favorable outcomes). Physician surveys were collected after each clinic and reviewed in aggregate. Results/Outcome(s): The tele-MDC underwent several preliminary sessions before formal data collection while the logistics were finalized. Since formal data collection began, four patients have been seen and evaluated. Patients were satisfied with the quality of care received (Likert scale mean-4.75), satisfied with the time spent with the team (4.75), felt involved in the discussion of their care plan (4.75), felt that the effort of the MDT was cooperative (4.75) and that they would recommend the clinic to other patients (4.75). Physicians reported that they were satisfied with the video (4.27) and audio (4.18) quality of the virtual clinic, and had a low degree of concern that the virtual format impeded clinical evaluation (1.81). Physicians also reported that they were satisfied with the teamwork (4.55), clear communication between team members (4.55), the quality of care provided (4.55), and that they were open to incorporating the virtual multidisciplinary clinic in their practice (4.36). Conclusions/Discussion: This preliminary pilot study demonstrates that a functional tele-MDC is a feasible alternative to in-person MDC during the COVID-19 pandemic, with the potential for a high degree of patient and physician satisfaction. Data are continuing to be collected and assessed as the experience continues.