R.I. leads antibiotic prescription decline in national effort curbing microbial resistance

RHODE ISLAND IS making better progress at reducing the number of antibiotics prescribed and filled, a strategy for slowing the development of microbial resistance to the drugs. / COURTESY BLUE CROSS & BLUE SHIELD OF RHODE ISLAND
RHODE ISLAND IS making better progress at reducing the number of antibiotics prescribed and filled, a strategy for slowing the development of microbial resistance to the drugs. / COURTESY BLUE CROSS & BLUE SHIELD OF RHODE ISLAND

PROVIDENCE – Rhode Island’s leading in the effort to curb unnecessary use of antibiotics, decreasing outpatient-filled prescriptions by 15 percent between 2010 and 2016, 6 percent more than the 9 percent national average, according to a Blue Cross Blue Shield Association study.

“Antibiotic resistance as a result of excessive use is a widespread problem, but these report results show that we are making progress in our collective commitment to confront this critical public health issue,” said Dr. Katherine Dallow, vice president of clinical affairs at Blue Cross & Blue Shield of Rhode Island.

The study also showed BCBSRI members filled 20 percent fewer broad-spectrum antibiotics, those that are typically used to treat a wide range of bacteria, compared to a 13 percent decline nationally.

Broad-spectrum antibiotics present a particular risk for antibiotic resistance, BCBSA reports.

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In 2016, health care professionals prescribed antibiotics in more than 20 percent of outpatient visits where their use is not indicated to treat the condition. Broad-spectrum antibiotics are used in most of those cases, according to BCBSA. That means the antibiotics were unnecessarily administered, giving bacteria an unnecessary chance to develop immunity to the drugs.

The Centers for Disease Control and Prevention reports that total inappropriate antibiotic use – which includes unnecessary antibiotic use, plus inappropriate antibiotic selection, dosing and duration – may approach 50 percent of all outpatient antibiotic use.

Simply using antibiotics generates antibiotic immunity, the CDC reports, since the drugs wind up in the environment, including inside people, and come into wide contact with bacteria. The bacteria that survive contact with antibiotics reproduce, passing their immunity on to their descendants.

CDC estimates that in the United States, more than 2 million people are sickened every year with antibiotic-resistant infections, with at least 23,000 dying as a result.

The decline in filled prescriptions in Rhode Island can be attributed to a variety of initiatives and strategies, including both provider- and patient-targeted initiatives, Dallow said.

The Patient-Centered Pharmacist Program, which embeds pharmacists in patient-centered medical homes, has been instrumental, she said. Pharmacists are the experts on antimicrobial selection and know the Ds – correct drug, dose, duration.

“As a result, having the pharmacists embedded in provider practices and educating both the prescribers and patients has certainly contributed to the decline,” Dallow said.

Under the PCPP, each system of care has developed its own internal antibiotic stewardship program, which utilizes data provided by BCBSRI to identify prescribing outliers and practice patterns. The teams meet with the providers in pods to educate on appropriateness of prescribing and then one-on-one when issues are identified.

“It is an ‘all hands on deck’ approach,” Dallow said.

Additionally, BCBSRI has participated in the statewide Antimicrobial Stewardship and Environmental Cleaning Task Force for the past couple of years, as well as the RI HAI Prevention and Antimicrobial Stewardship Coalition, which seeks to prevent health care-acquired infections and promote antimicrobial stewardship, through the quality improvement organization Healthcentric Advisors.

“There is always room to improve, and there are a multitude of interventions to improve antibiotic use. These include broad interventions such as prior authorization and audits, pharmacy-driven interventions such as automatic changes from intravenous to oral antibiotic therapy, dose adjustments and time-sensitive automatic stop orders. There are also infection- and syndrome-specific interventions, as well as better tracking and reporting,” Dallow said.

“A great deal of work has been done in Rhode Island to get these numbers to where they are, and it is great to see the impact that has had,” said Emily Cooper, senior program coordinator at Healthcentric Advisors, which has been commissioned by the R.I. Department of Health to aid the RI HAI Prevention and Antimicrobial Stewardship Coalition.

“Antimicrobial stewardship is as much about changing culture as it is about changing process. Our success in Rhode Island comes, in part, from our providers, health care facilities and stakeholders working collaboratively toward these changes. While there is room for improvement, I think we have only just begun to see the results of the programs that have been implemented in Rhode Island. The next step will be to more fully engage patients and families in antimicrobial stewardship and to help them be informed, active members of their or their loved ones’ care team,” Cooper said.

Rob Borkowski is a PBN staff writer. Email him at Borkowski@PBN.com.

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