{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:52:40Z","timestamp":1785412360682,"version":"3.56.0"},"reference-count":19,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"unspecified","delay-in-days":110,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ASHE"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S2732494X26103532_as1\">\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Developing, implementing, and evaluating the effectiveness of outpatient pediatric antimicrobial stewardship interventions via tele-stewardship<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X26103532_as2\">\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Baseline data collected between January and December 2022. Intervention data collected from February 2023 to December 2024. Interrupted time series with regression discontinuity analysis used to compare rates of antibiotic prescription between the periods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X26103532_as3\">\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Three pediatric primary care clinics and three emergency departments associated with Vanderbilt University Medical Center that served rural and suburban communities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X26103532_as4\">\n                    <jats:title>Participants:<\/jats:title>\n                    <jats:p>All encounters with patients less than 18 years of age at participating sites.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X26103532_as5\">\n                    <jats:title>Interventions:<\/jats:title>\n                    <jats:p>Intervention bundle included patient\/caregiver educational materials, antibiotic use commitment posters, prescriber education through quarterly teaching sessions on common pediatric infections, communication skills training, app-based microlearning modules, access to local guidelines using the Firstline app, and quarterly audit and feedback with peer comparison on guideline-concordant antibiotic use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X26103532_as7\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Among a total of 147,357 encounters (43,157 baseline, 100,200 intervention), overall percent of encounters with one or more antibiotics prescribed decreased from 12.4% to 11.9% (\n                      <jats:italic>P<\/jats:italic>\n                      = .01). Percent change varied by site and patient demographics. Overall guideline-concordant prescribing increased significantly for acute otitis media (77.7% baseline vs 85.7% intervention,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001), streptococcal pharyngitis (73.8% baseline vs 81.7% intervention,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001), and urinary tract infections (41.9% baseline vs 57.1% intervention\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001). Five-day antibiotic courses increased significantly (6.3% baseline vs 19.7% intervention,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001). There was a significant decrease in rapid streptococcal testing (10.9% baseline vs 7.6% intervention,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X26103532_as8\">\n                    <jats:title>Conclusions and Relevance:<\/jats:title>\n                    <jats:p>Tele-stewardship interventions were effective in outpatient pediatric primary care and emergency department settings, but effectiveness varied by site.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/ash.2026.10353","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T04:00:31Z","timestamp":1776744031000},"source":"Crossref","is-referenced-by-count":0,"title":["The impact of tele-stewardship on rural and suburban pediatric ambulatory antibiotic prescribing"],"prefix":"10.1017","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-3978-1836","authenticated-orcid":false,"given":"Matthew James","family":"Peworchik","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05dq2gs74","id-type":"ROR","asserted-by":"publisher"}],"name":"Vanderbilt University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritu","family":"Banerjee","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05dq2gs74","id-type":"ROR","asserted-by":"publisher"}],"name":"Vanderbilt University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7390-7947","authenticated-orcid":false,"given":"Henry","family":"Domenico","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4611-6861","authenticated-orcid":false,"given":"Sophie E.","family":"Katz","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05dq2gs74","id-type":"ROR","asserted-by":"publisher"}],"name":"Vanderbilt University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"S2732494X26103532_ref3","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofaa587"},{"key":"S2732494X26103532_ref7","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2024.88"},{"key":"S2732494X26103532_ref12","unstructured":"12. Dialogue Around Respiratory Illness Treatment (DART) \u2013 iMTR. https:\/\/www.uwimtr.org\/dart\/. Accessed May 12, 2021."},{"key":"S2732494X26103532_ref13","unstructured":"13. Talking with Vaccine Hesitant Patients. AAP. https:\/\/www.aap.org\/en\/patient-care\/immunizations\/."},{"key":"S2732494X26103532_ref17","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.13011"},{"key":"S2732494X26103532_ref15","unstructured":"15. Firstline. Firstline - Clinical Decision Support Platform. https:\/\/firstline.org\/. Accessed September 14, 2022."},{"key":"S2732494X26103532_ref14","unstructured":"14. QuizTime | Center for Advanced Mobile Healthcare Learning. https:\/\/www.vumc.org\/camhl\/quiztime. Accessed September 14, 2022."},{"key":"S2732494X26103532_ref19","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens14010060"},{"key":"S2732494X26103532_ref11","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-1071"},{"key":"S2732494X26103532_ref1","unstructured":"1. Antimicrobial Resistance Stats and Facts. Centers for Disease Control and Prevention. 2021. https:\/\/www.cdc.gov\/antimicrobial-resistance\/data-research\/facts-stats\/?CDC_AAref_Val= https:\/\/www.cdc.gov\/drugresistance\/national-estimates.html. Accessed December 18, 2024."},{"key":"S2732494X26103532_ref10","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir531"},{"key":"S2732494X26103532_ref4","doi-asserted-by":"publisher","DOI":"10.1093\/ajhp\/zxac179"},{"key":"S2732494X26103532_ref18","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkae002"},{"key":"S2732494X26103532_ref8","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-3488"},{"key":"S2732494X26103532_ref16","doi-asserted-by":"publisher","DOI":"10.1002\/sim.3340"},{"key":"S2732494X26103532_ref5","doi-asserted-by":"publisher","DOI":"10.1007\/s40506-021-00256-7"},{"key":"S2732494X26103532_ref9","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis629"},{"key":"S2732494X26103532_ref2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dks445"},{"key":"S2732494X26103532_ref6","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.6287"}],"container-title":["Antimicrobial Stewardship &amp; Healthcare Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S2732494X26103532","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T04:00:40Z","timestamp":1776744040000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S2732494X26103532\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026]]}},"alternative-id":["S2732494X26103532"],"URL":"https:\/\/doi.org\/10.1017\/ash.2026.10353","relation":{},"ISSN":["2732-494X"],"issn-type":[{"value":"2732-494X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"article-number":"e119"}}