Study Finds How Physicians Receive Feedback is Important for Antimicrobial Steward-ship



Antimicrobial resistance continues to increase, and antimicrobial stewardship programs are developing plans to report antimicrobial use in order to reduce and optimize the use of antibiotics.

Anticipation of how providers will receive feedback is important for antimicrobial stewardship programs to consider in order to optimize impact and create meaningful change, according to a recent Vanderbilt study published in the journal Infection Control & Hospital Epidemiology.

The study found that difficulties and barriers will always be present, but anticipating them will assist in successful implementation of quantitative antimicrobial use (AU) feedback and that there is not a one-size-fits-all approach for hospitals or for prescribers.

The study was based on a 20-question survey emailed to select adult inpatient providers at Vanderbilt University Adult Hospital. The survey included demographic questions, a hypothetical patient hospitalization scenario addressing antimicrobial attribution, preferred feedback methods and barriers and comparison metrics. The AU scenarios became progressively more complex, and providers were asked to rate concern about feedback barriers.

Respondents agreed upon attribution of antimicrobial use (AU) early in a hospital stay scenario, but disagreed once care became complex. They generally agreed on feedback methods, preferring electronic format, quarterly frequency, grouped by similar services and that the optimal comparator should be providers within the same clinical service. However, providers generally shared high levels of concern about feedback of quantitative AU data accounting for complexity of clinical care, severity of illness and accuracy.

The journal article notes that the study provides a framework for other institutions to implement AU feedback and that understanding provider opinions can improve acceptance, anticipate operational issues and inform educational messaging. Ultimately, it can help optimize antimicrobial use.

Tara Lines, PharmD, the study's lead author and first PGY2 Infectious Disease pharmacy resident at Vanderbilt, spoke about the significance of the findings. "Data can help drive change, but understanding behavior around how AU data are received is critical," she said. "This is the first study looking at provider opinions of AU feedback prior to providing feedback. The primary audience for these findings are anyone who would be involved in providing, interpreting, or receiving antimicrobial use data including, but not limited to, quality personnel, administrators, prescribers, nursing and pharmacy. Although the primary audience is broad, antimicrobial stewardship is everyone's responsibility."

George Nelson, MD, assistant professor of Medicine in the Division of Infectious Diseases and director of the Vanderbilt Antimicrobial Stewardship Program, said the study is a great start in understanding how best to approach delivering data on antibiotic use to providers. "Providing data on antimicrobial use is a necessary foundation to improve use, and, partnering with providers, is an extremely important step to ensure its success."