Year of Publication

2017

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Debbie Hampton

Clinical Mentor

Dr. Cheryl McClain

Committee Member

Dr. Chizimuzo Okoli

Abstract

Objective: In the “walk-in” portion of the Jessamine Medical and Diagnostic Center (JMC) primary care (PC) practice in Jessamine County, Kentucky, a combination patient and provider education program was implemented to assess its effects on antibiotic prescribing in respiratory tract infections (RTIs). The goal was to conduct an evaluation of the patient and provider education program at JMC, by specifically examining changes in immediate antibiotic prescribing in RTI (i.e., prescription given during visit to start taking immediately) one-year after implementation of the education program (March 1, 2015- February 28, 2016).

Methods: Utilizing a quasi-experimental pretest-posttest design, a retrospective electronic medical record review was conducted to determine if an antibiotic (immediate or delayed) was prescribed during the visit for RTI for 207 randomly selected patients who were evaluated by a full-time “walk-in” care provider during the established evaluation time periods.

Results: A total of 1,943 patients met initial inclusion and exclusion criteria. Through a random selection process, 207 patients (103 in the pre-intervention group and 104 in the post-intervention group) were included in the study. In the pre-intervention group, 58 were prescribed antibiotics, for an antibiotic prescription rate of 56.3%. Immediate antibiotics were prescribed in 32 of the encounters, for an immediate antibiotic prescribing rate of 31.1%. In the post-intervention group, antibiotics were prescribed in 30 of the 104 encounters, for a prescription rate of 28.8%. Immediate antibiotics were prescribed in only 14 of the 104 encounters, for a prescription rate of 13.5%. After the implementation of the intervention, there was a significant decrease in the number of antibiotics prescribed overall, Chi-square = 15.97 (DF = 1), p < .001, as well as in the number of immediate antibiotics prescribed, Chi-square = 9.28 (DF = 1), p < .05.

Conclusions: The number of immediate and total antibiotic prescriptions for RTI decreased significantly in the year following implementation of the education program. Further evaluation is needed to determine if long-term sustainability, further reduction in antibiotic prescribing, and dissemination to the entire clinic can be achieved. The results of this study demonstrate to practitioners that education interventions can be effective in rural settings and that changes in antibiotic prescribing are possible.

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