Researchers from Intermountain Medical Center have received a $786,000 grant to launch the largest study of its kind to examine antibiotic use and implement ways to optimize antibiotic prescribing in Utah’s small community hospitals.
Antibiotic stewardship programs, as they are called, have been shown to improve quality of care and appropriate antibiotic use in large medical centers. Now, researchers are looking to see if they can help deliver those same results in Utah’s smaller, community hospitals.
“Antibiotic stewardship programs focus on developing a structured approach to the use of antibiotics to achieve optimal outcomes,” says Eddie Stenehjem, MD, from the Department of Infectious Disease and Epidemiology at Intermountain Medical Center, and principal investigator of the study.
“In this study, we are focusing on the implementation and measuring the effectiveness of antibiotic stewardship programs in Utah’s small, community hospitals,” he says.
Though larger hospitals have implemented similar programs, small community hospitals generally lack antibiotic stewardship programs due to lack of infectious disease providers and varying rates of antibiotic utilization. Because of the lack of resources, such programs are difficult to implement and the appropriate level of antibiotic stewardship in smaller community hospitals is unknown.
Dr. Stenehjem and Whitney Redding, PharmD, from the Department of Pharmacy at Intermountain Medical Center, along with collaborators from the University of Utah, will use the grant sponsored from Pfizer and The Joint Commission to discover how much intervention is needed to optimize antibiotic use in small hospitals.
Researchers hope the study will answer two primary questions: 1) Is there a reduction in antibiotic use with interventions, and 2) does this result in a cost savings even with increased personnel time?
The overuse of antibiotics is a growing problem throughout the United States.
The American College of Physicians estimates that doctors prescribe 133 million courses of antibiotics each year. About 50 percent of these prescriptions are considered unnecessary since they’re prescribed for common viral infections such as the common cold or cough.
To combat the overuse of antibiotics and the development of bacterial superbugs, hospitals have implemented stewardship programs in hospitals to optimize antibiotic use.
Over the next six months, Dr. Stenehjem and his team at Intermountain Medical Center and the University of Utah will begin the development phase of the study, which consists of developing an educational curriculum for doctors and pharmacists, as well as expanding IT antibiotic surveillance tools in small community hospitals.
Later, they will enter the Intervention Phase, which will consist of a randomized trial of 15 Intermountain Healthcare community hospitals. The randomized trial will assign each hospital to one of three interventions (ranging from low to high resource utilization), in order to pinpoint the level of intervention needed to bring about change.
“This study will help us evaluate tools that can be used to ensure that we’re using the best antibiotics for each patient in every situation,” said Brent Wallace, MD, chief medical officer at Intermountain Healthcare. “Using the most effective tools makes it possible to make the correct drug selection consistently. Decreasing their use helps us prevent the spread and development of superbugs, which are resistant to most of our present antibiotics.”
“This is a very innovative study in that it will extend the benefits of antimicrobial stewardship to small hospitals and evaluate how the get the most efficient impact for the resources available within a health system,” said Andrew Pavia, MD, professor and chief of pediatric infectious diseases at the University of Utah and associate director of the Antimicrobial Stewardship Program at Primary Children’s Medical Center. “It is a great example of the benefits of partnership between Intermountain Healthcare and the University of Utah.”
The three purposes of the study include: expanding the antibiotic utilization surveillance system, comparing antibiotic utilization rates across the Intermountain Healthcare system, and defining the most appropriate antibiotic stewardship strategy.
“This study will help us find the sweet spot for what works and what doesn’t,” says Dr. Stenehjem. “Eventually, stewardship programs will be mandatory throughout the country for all hospitals, and what we find effective in Utah will be very applicable to small community hospitals everywhere.”
The full research team includes:
Edward Stenehjem, MD, MSc
Andrew Pavia, MD
John Burke, MD
Adam Hersh, MD, PhD
Emily Thorell, MD, MSci
Scott Evans, PhD
Whitney Redding, PharmD