Antimicrobial stewardship strategies and programs in the outpatient settings: a scoping review.

Abstract

Objective: To describe the evidence on antimicrobial stewardship programs (ASPs) and strategies implemented in outpatient settings.

Design: We conducted a scoping review to describe the evidence published since 2013 on the effects and implementation of outpatient ASP strategies and programs.

Methods: We searched Ovid MEDLINE, Embase, and Scopus from January 1, 2013 through September 3, 2024. Data were summarized in figures and tables. We categorized studies by types of ASP strategies and settings. We also summarize the reported outcomes using the RE-AIM framework.

Results: Of 29,544 unique citations/abstracts, 285 primary studies and 37 systematic reviews were eligible. Most included primary studies were observational (k = 226) and only 59 (21%) were randomized controlled trials (RCT). Most studies were conducted in primary care (k = 135) or emergency room/urgent care (k = 79). The most commonly evaluated individual strategies were patient and/or clinician education only (k = 55), audit and feedback (k = 48), and laboratory testing (k = 45). Overall antimicrobial and inappropriate prescribing rates were the most frequently assessed outcomes; patient treatment outcomes and health care utilization were also commonly reported.

Conclusions: There has been substantial growth in the evidence base, but this is largely from observational studies. Evidence gaps include a need for more controlled studies, and evaluation of additional outcomes. Few studies evaluated implementation costs or barriers, reach, and sustainability. Many of these additional outcomes would provide valuable insights to aid policy makers in the most feasible and appropriate strategies for implementation.