A Collaborative Approach to Promote Appropriate Antibiotic Use in Ambulatory Care Settings in Pennsylvania

Tuesday, June 21, 2016: 2:30 PM
Kahtnu 1, Dena'ina Convention Center
Nkuchia M M'ikanatha , Pennsylvania Department of Health, Harrisburgh, PA
Nicole Hackman , Penn State College of Medicine, Hershey, PA
Kristin Sznajder , Penn State College of Medicine, Hershey, PA
Courtney Yealy , Pennsylvania Department of Health, Harrisburg, PA
Erina McGeorge , Penn State University, University Park, PA
Rachel Smith , Penn State University, University Park, PA
Sameh W. Boktor , Pennsylvania Department of Health, Harrisburg, PA
BACKGROUND:  Antibiotic resistance is a serious threat to national and global public health.  Overuse and misuse of antibiotics, including prescriptions for acute upper respiratory infections, exacerbate the emergence of drug-resistant bacterial pathogens. Pennsylvania has implemented collaborative initiatives to promote antimicrobial stewardship in diverse settings.

METHODS: During 2005-2015, we implemented activities to promote antimicrobial stewardship in collaboration with the CDC Get Smart: Know When Antibiotics Work Program and academic partners. We organized program components by focus areas, developed specific interventions, and generated approaches for implementation and evaluation. Beginning in 2012, we engaged interns in the implementation of Get Smart activities under the guidance of the lead epidemiologist for antimicrobial resistance efforts. In 2015, Get Smart activities expanded significantly through collaborations and integration of data from community interventions and surveillance systems. The state approved a coordinator position. We successfully competed and received a grant to assess factors associated with vaccination coverage and antibiotic use among children and caregivers in Pennsylvania, focusing on childcare facilities.

RESULTS: During the past decade, we developed Get Smart initiatives focused on pediatric populations in collaboration with outpatient clinics, children’s hospitals and Keystone STARS, a childcare facilities’ quality improvement program. We created a web portal in 2013, and began an annual kids’ art competition to engage children 12 years and younger in promoting vaccinations and antibiotic stewardship. Using data from the program, we issued Practical Considerations for sick-child exclusions from childcare in 2014. The aim was to reinforce vaccinations for staff and children and prevent unnecessary exclusions of children with mild illnesses, such as low-grade fever, colored nasal discharge and conjunctivitis. In 2014, we introduced an experiential learning experience for pharmacy students at a large academic program. Through this program, students conducted surveys about antibiotic use among consumers in community pharmacies. We hosted events to observe annual Get Smart Week in various settings including academic medical centers and college campuses. In 2015, Pennsylvania Governor, Tom Wolf, issued a proclamation to increase public awareness about judicious antibiotic use in humans and animals.

CONCLUSIONS: We implemented, sustained, and expanded public health efforts to promote antimicrobial stewardship through collaboration with the CDC, academic, and community partners. Involvement of interns to coordinate activities, maintain the web portal and organize the kids’ art competition contributed to our success. Our experience suggests that creativity and diverse collaboration in program design can enhance efforts to promote antimicrobial stewardship.