Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

Introduction: Antibiotics are indispensable to maintaining human health; however, their overuse has resulted in resistant organisms, increasing morbidity, mortality and costs. Increasing antimicrobial resistance (AMR) is a major public health threat, resulting in multiple campaigns across countries to improve appropriate antimicrobial use. This includes addressing the overuse of antimicrobials for self-limiting infections, such as upper respiratory tract infections (URTIs), particularly in lower- and middle-income countries (LMICs) where there is the greatest inappropriate use and where antibiotic utilization has increased the most in recent years. Consequently, there is a need to document current practices and successful initiatives in LMICs to improve future antimicrobial use. Methodology: Documentation of current epidemiology and management of URTIs, particularly in LMICs, as well as campaigns to improve future antimicrobial use and their influence where known. Results: Much concern remains regarding the prescribing and dispensing of antibiotics for URTIs among LMICs. This includes considerable self-purchasing, up to 100% of pharmacies in some LMICs. However, multiple activities are now ongoing to improve future use. These incorporate educational initiatives among all key stakeholder groups, as well as legislation and other activities to reduce self-purchasing as part of National Action Plans (NAPs). Further activities are still needed however. These include increased physician and pharmacist education, starting in medical and pharmacy schools; greater monitoring of prescribing and dispensing practices, including the development of pertinent quality indicators; and targeted patient information and health education campaigns. It is recognized that such activities are more challenging in LMICs given more limited resources and a lack of healthcare professionals. Conclusion: Initiatives will grow across LMICs to reduce inappropriate prescribing and dispensing of antimicrobials for URTIs as part of NAPs and other activities, and these will be monitored

The Value Driven Pharmacist: Basics of Access, Cost, and Quality 2nd Edition

https://digitalcommons.butler.edu/butlerbooks/1017/thumbnail.jp

Adviser\u27s guide to health care: Volume 2, Professional Practices

https://egrove.olemiss.edu/aicpa_guides/1801/thumbnail.jp

Reducing Outpatient Antibiotic Resistance: A Quasi-Experimental Study

Approved May 2017 by the faculty of UMKC in partial fulfillment of the requirements for the degree of Doctor of Nursing PracticeApproximately 50% of antibiotics prescribed are not necessary, nevertheless in the United States among the many outpatient prescriptions, few are more widely prescribed than antibiotics. The inappropriate use of antibiotics to treat non-bacterial infections has been largely responsible for the emergence of antibiotic resistance. The purpose of this DNP project was to evaluate the effect of an antibiotic stewardship program on urgent care providers’ antibiotic prescribing for acute respiratory infections and to analyze providers’ awareness and beliefs regarding antibiotic use and resistance. A quasi-experimental study was conducted among a convenience sample of eight urgent care providers who received a one hour theory-based intervention program on antibiotic prescribing. Outcomes measured included provider antibiotic prescribing rates pre- and post-intervention, differences in antibiotic prescribing among the providers, and provider attitude and knowledge regarding antibiotic prescribing and resistance. The antibiotic prescribing rate decreased from 30% to 20% post-intervention, p =. 078. The odds ratio of nurse practitioners preferring not to prescribe antibiotics pre-intervention was 3.273 (p = .001) and post-intervention 4.155 (p = < .0005) times more than physicians. Within their setting, 84.43% believed antibiotics are overused, and 92.25% believed antibiotic resistance is a problem. Implementation of an outpatient antibiotic stewardship program is necessary to decrease inappropriate antibiotic prescribing, slow progression of antibiotic resistance, and decrease healthcare costs associated with this world-wide public health problem

Child Health Supervision: Analytical Studies in the Financing, Delivery, and Cost-Effectiveness of Preventive and Health Promotion Services for Infants, Children, and Adolescents

Contents: Financing and Delivery of Child Health Supervision Services (An Overview of Health Insurance Coverage and Access to Child Health Supervision Services, Private Health Insurance Coverage of Preventive Benefits for Children, A 20-Year Retrospective of Child Health Supervision in Ambulatory Pediatric Settings, Ensuring Adequate Health Care Benefits for Children and Adolescents); Child Health Supervision Services and Medicaid (Informing State Medicaid Providers about EPSDT, Barriers to Full Participation in EPSDT and Possible Strategies for the Maternal and Child Bureau, Medicaid Managed Care: A Briefing Book on Issues for Children and Adolescents; State Implementation of OBRA \u2789 EPSDT Amendments within Medicaid Managed Care Arrangements)

International Profiles of Health Care Systems, 2011

This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views

The Value Driven Pharmacist: Basics of Access, Cost and Quality

https://digitalcommons.butler.edu/butlerbooks/1015/thumbnail.jp

Quality of Health Care for Medicare Beneficiaries: A Chartbook

Provides the results of a review of recently published studies and reports about the quality of health care for elderly Medicare beneficiaries. Includes examples of deficiencies and disparities in care, and some promising quality improvement initiatives

The Use of the Centers for Disease Control (CDC) Outpatient Antibiotic Stewardship Program to Reduce Unnecessary Antibiotic Prescriptions Written for Sinusitis in a Rural Urgent Care Clinic Setting

Background: The discovery of antibiotics has been a significant success in fighting bacterial infections. According to the Centers for Disease Control (CDC), in 2018, inappropriate prescribing of antibiotics contributed to antibiotic-resistant conditions, which led to 2 million infections, and has killed about 23,000 Americans annually (Chaney, 2018: CDC, 2019). By 2050, 10 million people are expected to die globally due to bacterial resistance, with the cost potentially reaching $100 trillion (WHO, 2019). Purpose: The purpose of the DNP Project is to decrease unnecessary antibiotic prescriptions for the diagnosis of sinusitis in a rural urgent care clinic and increase provider awareness of the importance of appropriate antibiotic use. Methods: A quality improvement project was performed by implementing a pre-and post-test to clinicians in a rural urgent care clinic. Post-testing followed a didactic PowerPoint presentation consisting of CDC guidelines for diagnosing and treating sinusitis. Results: Statistical results identified the provider’s use of the most appropriate antibiotics improved after completing the didactic requirements. Statistical data showed no decrease in the prescribing of antibiotics for the treatment of sinusitis. Statistical data supports the providers’ knowledge in diagnosing bacterial versus viral sinusitis. Conclusion: The project helped identify the importance of the appropriate distribution of antibiotics and the need to avoid inappropriate and unnecessary use when treating patients in the urgent care clinic setting

Antibiotic Stewardship Among Primary Care Providers In Mississippi

The World Health Organization states antimicrobial resistance is the ability of a microorganism to stop an antimicrobial from working which results in ineffective treatment and persistent infections. The Center for Disease Control and Prevention (CDC, 2017) reported that in the year 2015, 269.4 million antibiotic prescriptions were written in the outpatient setting, and approximately 30% of antibiotics written are unwarranted. Of those cases, most patients receive an antibiotic related to acute uncomplicated bronchitis, pharyngitis, or rhinosinusitis. The CDC reported that Americans spend nearly $11 billion yearly on antibiotics alone. However, up to 50% of all antibiotics prescribed are not indicated or optimally effective which eventually leads to resistance. Antibiotic resistant infections are associated with loss of productivity, poorer health outcomes, and greater healthcare costs. The CDC launched The Get Smart: Know When Antibiotics Work campaign in 2003 which aimed to direct appropriate antibiotic use (CDC, 2017). Within this campaign, the CDC provides outpatient regarding condition, epidemiology, diagnosis, and management for providers to follow for appropriate prescription. The purpose of this study was to determine if primary care providers in Mississippi are following the CDC Adult Treatment Recommendations for antibiotic use in the treatment of acute uncomplicated bronchitis, streptococcal pharyngitis, and acute unspecified pharyngitis (CDC, 2016). The researchers collected data in six rural clinics across Mississippi. This study consisted of a quantitative, retrospective chart review with descriptive statistics. A convenience sampling of 582 charts were obtained for the retrospective review. For data collection, the researchers used a data collection tool which included information related to age, gender, insurance, title o f provider, and diagnoses related to the current research and CDC Adult Treatment Recommendations. Prior to conducting the study, consent was obtained from the Institutional Review Board (IRB) at the Mississippi University for Women. After data collection, data were subjected to analyses using descriptive statistics including, but not limited to, frequency, distributions, and percentages. The findings suggested that primary care providers in Mississippi are not consistently following the CDC Adult Treatment Recommendations for acute pharyngitis and uncomplicated bronchitis