New Standards Require Antibiotic Stewardship in Outpatient Settings

Other stakeholders should also act to improve prescribing practices in these facilities

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New Standards Require Antibiotic Stewardship in Outpatient Settings
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A leading nonprofit health care certification organization—The Joint Commission—will require antibiotic stewardship efforts in the outpatient facilities it accredits starting in January.

This initiative will help ensure appropriate prescribing in these settings and minimize the threat of antibiotic resistance. The Joint Commission had already taken a leading role in this area when it required stewardship programs in hospitals and nursing homes starting in 2017. The new standard would apply to over 2,200 free-standing ambulatory care centers currently accredited by the organization. Those facilities include, for example, medical group practices, community health centers, dental practices, dialysis centers, and urgent care centers.

Other stakeholders should follow The Joint Commission’s lead in prioritizing antibiotic stewardship in outpatient settings. The centers that elect to be accredited by the organization represent a small subset of the outpatient facilities across the United States. Wider implementation of outpatient antibiotic stewardship will require concerted action by key public health partners.

Health insurance plans can provide feedback on antibiotic prescribing practices to their outpatient health care providers, as well as educational materials, to encourage appropriate prescribing. Some insurance companies are already doing this. For example, Aetna reviews its claims data and sends personalized letters to providers within its network who prescribe antibiotics inappropriately. The company also congratulates those who prescribe according to medical guidelines. In addition, health plans can integrate incentives for appropriate antibiotic prescribing into existing value-based purchasing and quality improvement programs.

Health systems—networks of practices that coordinate and manage patient care within a geographic area—can expand inpatient stewardship programs to incorporate outpatient facilities. That would help them leverage resources to promote appropriate prescribing across all facilities. For example, they can use data from shared electronic health record systems to audit and provide feedback on outpatient antibiotic prescribing practices. Health systems can also work to develop financial incentives for improved prescribing for their outpatient providers.

State and local health agencies can provide educational resources to providers, health plans, and health systems to help outpatient facilities implement antibiotic stewardship best practices. These agencies can also facilitate partnerships among health care stakeholders to improve antibiotic use across a geographic area.

The Joint Commission’s new standard requiring antibiotic stewardship activities in outpatient facilities underscores the organization’s continued leadership role in the fight against antibiotic resistance. It also provides an opportunity for health plans, health systems, and other health care stakeholders to encourage better antibiotic prescribing across all outpatient settings in the U.S.

David Hyun, M.D., is a senior officer and Rachel Zetts, M.P.H, is an officer with The Pew Charitable Trusts’ antibiotic resistance project.

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Antibiotic use in outpatient health care settings, such as primary care offices and emergency rooms, represents the majority of dollars spent on antibiotics for human health care in the United States. Beginning in 2015, The Pew Charitable Trusts convened a panel of experts, including representatives from the Centers for Disease Control and Prevention (CDC) and other public health and medical experts to analyze current outpatient antibiotic prescribing habits in the United States, determine targets for reducing inappropriate prescribing, and identify steps needed to reach these targets.

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