Reducing Inappropriate Antibiotic Prescribing in Pharyngitis: Implementation of the Mitigate Toolkit

Purpose: In the outpatient setting up to 30% of antibiotic prescribing is unnecessary according to the Center for Disease Control. This amount of antibiotic overprescribing or inappropriate prescribing has led to increased health care costs related to adverse reactions and development of new antibiotic resistant bacteria. Pharyngitis which is most prevalent in children aged 5-15 years is associated with antibiotic overuse caused by overdiagnosis of bacterial etiology versus viral etiology.

Background: In the urgent care setting overprescribing can be attributed to factors that include clinician knowledge gaps, gaps about best practices and clinical practice guidelines, clinician perception of patient expectations, pressure to see patients quickly, and decreased patient satisfaction (Sanchez et al., 2016).

 
Methods: A retrospective chart audit of the EHR was completed to establish a baseline of antibiotic prescribing practices at an urgent care setting. Four out of the six MITIGATE toolkit components were incorporated: provider education, provider commitment-enhanced patient education, program champion and personalized feedback to the providers. Prescribing rates were then analyzed pre and post interventions.

Results: The percentage of those presenting with diagnosis of pharyngitis that receive an inappropriate antibiotic decreased from 8% to 0%. The percentage that received an unnecessary antibiotic decreased from 22% to 1%.

 
Conclusion: Current assessment and treatment of those age 5-15 years with diagnosis of pharyngitis has resulted in appropriate antibiotic prescribing. The Plan-Do-Study-Act Model 
(PDSA) has led to successful use of the MITIGATE toolkit components for the appropriate prescribing practices for those patients presenting with pharyngitis.