Journal article
The use of telehealth-supported stewardship activities in acute-care and long-term care settings: An implementation effectiveness trial
Infection control and hospital epidemiology, Vol.44(12), pp.2028-2035
12/2023
DOI: 10.1017/ice.2023.81
PMCID: PMC10755161
PMID: 37312262
Appears in UI Libraries Support Open Access
Abstract
Background:
We assessed the implementation of telehealth-supported stewardship activities in acute-care units and long-term care (LTC) units in Veterans’ Administration medical centers (VAMCs).
Design:
Before-and-after, quasi-experimental implementation effectiveness study with a baseline period (2019–2020) and an intervention period (2021).
Setting:
The study was conducted in 3 VAMCs without onsite infectious disease (ID) support.
Participants:
The study included inpatient providers at participating sites who prescribe antibiotics.
Intervention:
During 2021, an ID physician met virtually 3 times per week with the stewardship pharmacist at each participating VAMC to review patients on antibiotics in acute-care units and LTC units. Real-time feedback on prescribing antibiotics was given to providers. Additional implementation strategies included stakeholder engagement, education, and quality monitoring.
Methods:
The reach–effectiveness–adoption–implementation–maintenance (RE-AIM) framework was used for program evaluation. The primary outcome of effectiveness was antibiotic days of therapy (DOT) per 1,000 days present aggregated across all 3 sites. An interrupted time-series analysis was performed to compare this rate during the intervention and baseline periods. Electronic surveys, periodic reflections, and semistructured interviews were used to assess other RE-AIM outcomes.
Results:
The telehealth program reviewed 502 unique patients and made 681 recommendations to 24 providers; 77% of recommendations were accepted. After program initiation, antibiotic DOT immediately decreased in the LTC units (−30%; P < .01) without a significant immediate change in the acute-care units (+16%; P = .22); thereafter DOT remained stable in both settings. Providers generally appreciated feedback and collaborative discussions.
Conclusions:
The implementation of our telehealth program was associated with reductions in antibiotic use in the LTC units but not in the smaller acute-care units. Overall, providers perceived the intervention as acceptable. Wider implementation of telehealth-supported stewardship activities may achieve reductions in antibiotic use.
Details
- Title: Subtitle
- The use of telehealth-supported stewardship activities in acute-care and long-term care settings: An implementation effectiveness trial
- Creators
- Daniel J Livorsi - Iowa City VA Health Care SystemStacey Hockett Sherlock - Iowa City VA Health Care SystemCassie Cunningham GoedkenSandra Pratt - John J. Pershing VA Medical CenterDavid A Goodman - Bath VA Medical CenterKim C Clarke - Carl Vinson VA Medical CenterHyunkeun Cho - University of IowaHeather Schacht ReisingerEli N Perencevich - Iowa City VA Health Care System
- Resource Type
- Journal article
- Publication Details
- Infection control and hospital epidemiology, Vol.44(12), pp.2028-2035
- DOI
- 10.1017/ice.2023.81
- PMID
- 37312262
- PMCID
- PMC10755161
- NLM abbreviation
- Infect Control Hosp Epidemiol
- eISSN
- 1559-6834
- Publisher
- Cambridge University Press
- Language
- English
- Electronic publication date
- 06/14/2023
- Date published
- 12/2023
- Academic Unit
- Infectious Diseases; Epidemiology; Biostatistics; Center for Social Science Innovation; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984433855202771
Metrics
22 Record Views