Summer 2018 Issue
to Home Page
Urgent Care Antibiotic Stewardship
By Jill Obremskey, MD, MMHC, FAAP
Antibiotic resistance is a major public health threat. In the United States alone, the Centers for Disease Control and Prevention estimates that at least 2,000,000 illnesses and 23,000 deaths are caused by antibiotic-resistance each year. The National Strategy for Combating Antibiotic-Resistant Bacteria was developed by the White House in 2014 as a guidance for the National Action Plan for Combating Antibiotic Resistant Bacteria (2015). (1) One of the components of this plan was setting national goals for healthcare antibiotic stewardship. One of the pertinent goals for UC reads: By 2020, inappropriate outpatient antibiotic use for monitored conditions/agents will be reduced by 50% from 2010 levels.
As we know, urgent care clinics see a disproportionate proportion of patients with infectious disease associated symptoms. Based on CDC estimates of antibiotic prescribing rates in urgent care visits, (approx 40%), urgent care could account for 32 to 40 million antibiotic prescriptions each year (2). Urgent care centers have unique opportunities to significantly improve outpatient antibiotic prescribing, enhance patient care quality, and combat antibiotic resistance through antibiotic stewardship.
However, it is recognized that the national plan requires cooperation of federal agencies, private sector and other stakeholders. The Society for Pediatric Urgent Care was invited to a summit hosted by the CDC and Antibiotic Resistance Action Center (ARAC); and included Payers, EHR vendors, UCA and urgent care leaders in July to discuss barriers and bring solutions to antibiotic stewardship in the urgent care space.
We look forward to continuing to work with the CDC and ARAC for input on antibiotic stewardship for the pediatric population. In coordination with the CDC and ARAC, SPUC plans to offer our members resources to implement and monitor initiatives for appropriate antibiotic use and to change the culture of antibiotic usage across the pediatric urgent care community.
Please consider attending the SPUC Conference this October as there will be a special session on this hot topic during the Leadership Summit.
Pediatric Urgent Care Antimicrobial Stewardship Survey
Thank you to all for completing the survey by ARAC to explore some characteristics of the Pediatric Urgent Care industry in order to understand the landscape for the summit. The results of our survey follow. We had 45 respondents out of a total membership of 330. As respondents were individuals and not distinct urgent care organizations, the results are not to be considered a fully accurate representation of the pediatric urgent care landscape.
- How many urgent care centers are part of your organization?
- Most pediatric urgent care organizations had between two and five centers
- No pediatric urgent care organizations had more than 20 centers
- Which part of the country are your centers located?
- Most respondents were from the Southeast and Midwest.
- All areas of the continental US were represented
- What is the greatest volume seen by one of your sites in Calendar year 2017?
- 40% of respondents saw between 20,000 and 40,000 patients per clinic in 2017
- Two centers saw more than 40,000 patients in 2017
- Two centers saw less than 5000 patients in 2017
- Which EHR do you use to document a patient visit?
- Almost all centers use EPIC or Cerner
- One center used Docutap
- Other EHR include eMDs – 2, All Scripts – 2, Practice Velocity – 2
- Four centers used another not listed
- What is your percent Medicare/Medicaid
- 24.4% of respondents did not know
- 22.22% of respondents reported 40-50%
- 24.44% of respondents reported >50%
- What is your certification and/or accreditation status?
- 12 (26.6%) were certified
- 21 (46.67%) were accredited
- 12 (26.67%) were not accredited or certified
- Who Provides our certification/accreditation?
- UCAOA – 1
- Joint Commission (This would be as part of the hospital) – 23
- DNV – 6
- DNR – 1
- Other – 9
- Do you track the following HEDIS Measure? If yes, what is your score?
Appropriate testing for children with pharyngitis: Percentage of children 2 to 18 years of age who were diagnosed with pharyngitis, prescribed an antibiotic and received a group A Streptococcus (strep) test for the episode.- 16 report
- If known, Scores were 90-100
- Do you track the following HEDIS measures? If so, what are your scores?
Appropriate treatment for children with upper respiratory infection (URI): Percentage of children 3 months to 18 years of age with a diagnosis of URI who were not prescribed antibiotics on or three days after the episode date.- 11 report
- If known, Scores were 90-100
- Do you track the following HEDIS measures? If so, what are your scores?
Antibiotic utilization: This measure summarizes data on outpatient utilization of drug prescriptions, stratified by age, and evaluates many factors, including total number of antibiotic prescriptions, average number of prescriptions per year, and use of antibiotics of concern, including current first-line antibiotics for pharyngitis, URI, acute bronchitis, otitis media, and UTIs.- 6 report
- No scores were submitted
Citations:
- National Action Plan for Combating Antibiotic-Resistant Bacteria.
https://obamawhitehouse.archives.gov/sites/default/files/docs/national_action_plan_for_combating_antibiotic_resistant_bacteria.pd - Palms D, Hicks L, Hersh AL, et al. Variation in Antibiotic Prescribing Among Emergency Departments, Urgent Care Centers and Retail Health Clinics in the United States, 2014. Open Forum Infectious Diseases. 2017;4(Suppl 1):S507
JOIN OR RENEW WITH SPUC TODAY!
PLAN NOW!
SPUC Fourth Annual Conference
October 5-7, 2018
Nemours Children’s Hospital
Orlando, FL
Leadership Summit: October 4, 2018
Get the Mobile Meeting Guide HERE!
_____________
Committee Opportunities
Want to make a difference in our developing specialty of Urgent Care Pediatrics?
Join a SPUC Committee or workgroup!