Implementation of an Interprofessional Delayed Antibiotic Prescribing and Patient Education Initiative in a Walk-In Clinic Setting

Patients with respiratory infections frequently present to walk-in clinics and receive precautionary antibiotic prescriptions for illnesses that may actually be viral in origin. Antibiotic overuse and misuse is a recognized problem in the healthcare system, with unnecessary and nonadherent antibiotic use contributing to antibiotic resistance. The U.S. Centers for Disease Control and Prevention (CDC) has developed a delayed antibiotic prescribing tool, which may decrease inappropriate antibiotic use when incorporated into clinical practice. Additionally, patient education and behavioral modification tools have been shown to improve patient adherence when antibiotic therapy is clinically indicated. To investigate these interventions further, an interprofessional student team involving MD, NP and PharmD students developed a quality improvement initiative aimed at demonstrating that the implementation of a combined delayed prescribing and patient education practice reduces antibiotic use among walk-in clinic patients with mild to moderate upper respiratory infections. Patients were provided with educational materials outlining the benefits of antibiotic stewardship, delayed prescribing practices, and behavioral tools to practice if they filled their prescription. Following evaluation and education, the patients were provided with an appropriate antibiotic prescription that they could fill if their symptoms persisted or worsened following the clinic visit. This design empowered the patient and directly brought the patient into the decision-making process. The interprofessional student team later contacted the patient’s pharmacy to determine if the prescription had been filled and documented the delay interval, if applicable. Our team demonstrated that with this intervention, a substantial portion of patients did not fill their prescription, and in those who did, a subset were able to effectively delay filling their prescription, all without an increase in return clinic visits for refractory or worsening symptoms within 2 weeks of the index visit. Our team concluded that this interprofessional patient education and delayed prescribing intervention is feasible in the walk-in clinic setting. With large scale implementation, this could improve antibiotic stewardship and understanding of proper antibiotic use in the community. However, further study involving randomization and a defined control group will be necessary in order to provide more robust support for this intervention. In addition to demonstrating positive clinical outcomes, the success of this project has reinforced the importance of incorporating multiple interprofessional perspectives when designing a research study. By incorporating the perspectives of multiple professions, our team was able to analyze the effects of our project on the patient and the medical system from multiple professional perspectives.