Bethany Wattles, who holds a doctorate in pharmacy, is an assistant professor of pediatrics at the University of Louisville School of Medicine with a longtime interest in initiatives dedicated to improving antibiotic use—often referred to as antibiotic stewardship programs. As part of a partnership with the Kentucky Department for Medicaid Services, Wattles was one of the first in the country to utilize a new open-source tool—the Outpatient Automated Stewardship Information System (OASIS)—to help improve antibiotic use statewide. This stewardship tool was created with support from The Pew Charitable Trusts.
This interview has been edited for clarity and length.
Q: How did you first become interested in antibiotic stewardship?
A: I really started to become fascinated by the fundamental role of antibiotics in medicine, and the importance of stewardship, when I was in pharmacy school. In residency, I saw firsthand how antibiotics were integral to so many different medical specialties—and also how these drugs were no longer working the way they used to. It was alarming, with implications for literally every one of us—from the smallest babies to even the healthiest of adults. I remember wanting to warn my family and to do something about the problem as quickly as possible because it was abundantly clear to me that without better stewardship, we weren’t going to continue to have effective antibiotics in the future.
Q: What have you found most rewarding about your antibiotic stewardship work?
A: I really enjoy the multidisciplinary collaboration of stewardship—working with different clinicians throughout the hospital and with different research departments, from statisticians to public health officials to Ph.D.s. Ultimately, stewardship is a team sport; to be effective, you really need an inclusive approach. That said, there’s a lot of work yet to do.
Q: How so?
A: Inappropriate prescribing continues to be a big problem—especially here in Kentucky. In fact, when we launched the University of Louisville’s partnership with the state Department for Medicaid Services—Kentucky Medicaid for short—Kentucky was using more antibiotics per capita than any state in the country.
Q: How did you first learn about OASIS (Outpatient Automated Stewardship Information System)?
A: The first time I heard about OASIS, I don’t think it was even called OASIS yet. I remember one of the creators, Dr. Holly Frost from Denver Health, presented on the new tool a couple of years ago at IDWeek, one of the biggest infectious disease conferences in the U.S.
And I had the sense right away that OASIS could be helpful to our efforts to improve antibiotic prescribing that were already underway in Kentucky. I especially liked that OASIS was easily scalable and automated, which we needed for a statewide effort involving more than 4,000 providers.
Q: Now that you’ve begun using OASIS, what has your focus been?
A: To date, we’ve used OASIS to address antibiotic prescribing to children in Kentucky. There’s a lot of variation in pediatric antibiotic prescribing here—with children in more rural areas receiving antibiotics up to three times more frequently than kids who live in other parts of the state. Using state Medicaid data, OASIS helped us generate letters to all Kentucky health care providers who wrote at least 12 antibiotic prescriptions to children per year. These letters gave providers data on their prescribing habits and context for how they compared to their peers across the state.
Q: Did that have an impact?
A: We heard back from numerous providers after we shared this data, and many of them expressed appreciation for the information—which they wouldn’t have had the resources to aggregate and distribute on their own. We need more time and data to evaluate what effect the OASIS data and communications are having on prescribing across the state, but in the interim the letters have received positive feedback and have helped open up a dialogue about antibiotic prescribing that we didn’t have previously.
Q: What can other stewardship leaders learn from how you’ve leveraged OASIS?
A: For me, the main takeaway from our experience with OASIS is that statewide stewardship efforts are possible, including individualized tracking and assessment of antibiotic prescribing on a broad scale. The plug-and-play nature of OASIS means users don’t have to reinvent the wheel, write their own statistical code, or create their own metrics from scratch—which helps make stewardship activities very feasible and time efficient, regardless of what type of data you’re working with and what format it’s in.
Additionally, OASIS gives users the ability to upload and share their projects so that others can see and draw on specific examples of how the tool has been used. In this spirit of transparency and collaboration, we have shared our project on OASIS, and we hope that others can use our experience to further advance stewardship efforts in their own areas.
Q: With the creation of automated tools like OASIS, what do you hope to see in antibiotic stewardship over the next five to 10 years?
A: In the next five to 10 years, I expect we’ll have a lot more data that concretely shows the positive impact of our current and future stewardship efforts. In the interim, there’s definitely an opportunity to broaden our efforts even more—beyond pediatric prescribing, beyond just Medicaid data, etc. I’d love to start collaborating with private insurers, state departments of public health, and other partners, and integrating claims data and other data sources to generate more detailed reports to a larger group of providers. Really, any opportunity to engage additional stakeholders and their data in support of stewardship will be important to driving progress.
We’re also interested in exploring multistate stewardship collaborations. For example, West Virginia is doing similar work using Medicaid claims data, with a goal of creating a statewide dashboard for prescribers. It would make our stewardship efforts even more efficient and impactful if we pooled our data and worked together.
Tools like OASIS and data from organizations like the Centers for Disease Control and Prevention provide us with useful metrics and ways to measure success, and it’s encouraging to be able to see that what we’re doing is having an impact. But we still have a long way to go.
West Virginia’s work to create a statewide dashboard for prescribers is supported in part by The Pew Charitable Trusts.