{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:05:35Z","timestamp":1791979535180,"version":"4.4.0"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Urgent Care (UC) encounters result in more inappropriate antibiotic prescriptions than other outpatient setting. Few stewardship interventions have focused on UC.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the effectiveness of an antibiotic stewardship initiative to reduce antibiotic prescribing for respiratory conditions in a UC network.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This quality improvement study conducted in a UC network with 38 UC clinics and 1 telemedicine clinic included 493\u202f724 total UC encounters. The study compared the antibiotic prescribing rates of all UC clinicians who encountered respiratory conditions for a 12-month baseline period (July 1, 2018, through June 30, 2019) with an intervention period (July 1, 2019, through June 30, 2020). A sustainability period (July 1, 2020, through June 30, 2021) was added post hoc.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Stewardship interventions included (1) education for clinicians and patients, (2) electronic health record (EHR) tools, (3) a transparent clinician benchmarking dashboard, and (4) media. Occurring independently but concurrent with the interventions, a stewardship measure was introduced by UC leadership into the quality measures, including a financial incentive.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was the percentage of UC encounters with an antibiotic prescription for a respiratory condition. Secondary outcomes included antibiotic prescribing when antibiotics were not indicated (tier 3 encounters) and first-line antibiotics for acute otitis media, sinusitis, and pharyngitis. Interrupted time series with binomial generalized estimating equations were used to compare periods.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The baseline period included 207\u202f047 UC encounters for respiratory conditions (56.8% female; mean [SD] age, 30.0 [21.4] years; 92.0% White race); the intervention period included 183\u202f893 UC encounters (56.4% female; mean [SD] age, 30.7 [20.8] years; 91.2% White race). Antibiotic prescribing for respiratory conditions decreased from 47.8% (baseline) to 33.3% (intervention). During the initial intervention month, a 22% reduction in antibiotic prescribing occurred (odds ratio [OR], 0.78; 95% CI, 0.71-0.86). Antibiotic prescriptions decreased by 5% monthly during the intervention (OR, 0.95; 95% CI, 0.94-0.96). Antibiotic prescribing for tier 3 encounters decreased by 47% (OR, 0.53; 95% CI, 0.44-63), and first-line antibiotic prescriptions increased by 18% (OR, 1.18; 95% CI, 1.09-1.29) during the initial intervention month. Antibiotic prescriptions for tier 3 encounters decreased by an additional 4% each month (OR, 0.96; 95% CI, 0.94-0.98), whereas first-line antibiotic prescriptions did not change (OR, 1.00; 95% CI, 0.99-1.01). Antibiotic prescribing for respiratory conditions remained stable in the sustainability period.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and relevance<\/jats:title>\n The findings of this quality improvement study indicated that a UC antibiotic stewardship initiative was associated with decreased antibiotic prescribing for respiratory conditions. This study provides a model for UC antibiotic stewardship.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.13011","type":"journal-article","created":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T11:03:13Z","timestamp":1683802993000},"page":"e2313011","source":"Crossref","is-referenced-by-count":48,"title":["Implementation of an Antibiotic Stewardship Initiative in a Large Urgent Care Network"],"prefix":"10.1001","volume":"6","author":[{"given":"Edward","family":"Stenehjem","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases and Epidemiology, Intermountain Health, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Wallin","sequence":"additional","affiliation":[{"name":"Intermountain Urgent Care, Intermountain Health, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Park","family":"Willis","sequence":"additional","affiliation":[{"name":"Intermountain Urgent Care, Intermountain Health, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naresh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Office of Research, Intermountain Health, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan M.","family":"Seibert","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Epidemiology, Intermountain Health, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Whitney R.","family":"Buckel","sequence":"additional","affiliation":[{"name":"System Pharmacy Services, Intermountain Health, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valoree","family":"Stanfield","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Epidemiology, Intermountain Health, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly D.","family":"Brunisholz","sequence":"additional","affiliation":[{"name":"Intermountain Health Delivery Institute, Intermountain Health, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora","family":"Fino","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew H.","family":"Samore","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajendu","family":"Srivastava","sequence":"additional","affiliation":[{"name":"Intermountain Health Delivery Institute, Intermountain Health, Salt Lake City, Utah"},{"name":"Department of Pediatrics, Division of Pediatric Inpatient Medicine, University of Utah School of Medicine, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauri A.","family":"Hicks","sequence":"additional","affiliation":[{"name":"Office of Antibiotic Stewardship, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam L.","family":"Hersh","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,5,11]]},"reference":[{"issue":"17","key":"zoi230400r1","doi-asserted-by":"publisher","first-page":"1864","DOI":"10.1001\/jama.2016.4151","article-title":"Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 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