JAMMI最新文献

{"title":"HIV treatment outcomes among newcomers living with HIV in Manitoba, Canada.","authors":"Charity Maritim,&nbsp;Leigh McClarty,&nbsp;Stella Leung,&nbsp;Sharon Bruce,&nbsp;Gayle Restall,&nbsp;Paula Migliardi,&nbsp;Marissa Becker","doi":"10.3138/jammi-2020-0042","DOIUrl":"https://doi.org/10.3138/jammi-2020-0042","url":null,"abstract":"<p><strong>Background: </strong>Despite the overrepresentation of immigrants and refugees (newcomers) in the HIV epidemic in Canada, research on their HIV treatment outcomes is limited. This study addressed this knowledge gap by describing treatment outcomes of newcomers in comparison with Canadian-born persons living with HIV in Manitoba.</p><p><strong>Methods: </strong>Clinical data from 1986 to 2017 were obtained from a cohort of people living with HIV and receiving care from the Manitoba HIV Program. Retrospective cohort analysis of secondary data was completed using univariate and multivariate statistics to compare differences in socio-demographic and clinical characteristics and treatment outcomes among newcomers, Canadian-born Indigenous persons, and Canadian-born non-Indigenous persons on entry into HIV care.</p><p><strong>Results: </strong>By end of 2017, 86 newcomers, 259 Canadian-born Indigenous persons, and 356 Canadian-born non-Indigenous persons were enrolled in the cohort. Newcomers were more likely than Canadian-born Indigenous and non- Indigenous cohort participants to be younger and female and have self-reported HIV risk exposure as heterosexual contact. Average CD4 counts at entry into care did not differ significantly between groups. A higher proportion of newcomers was also diagnosed with tuberculosis within 6 months of entry into care (21%), compared with 6% and 0.6% of Canadian-born Indigenous non-Indigenous persons, respectively. Newcomers and Canadian-born non-Indigenous persons had achieved viral load suppression (< 200 copies/mL) at a similar proportion (93%), compared with 82% of Canadian-born Indigenous participants (<i>p</i> < 0.05).</p><p><strong>Conclusions: </strong>The distinct demographic and clinical characteristics of newcomers living with HIV requires a focused approach to facilitate earlier diagnosis, engagement, and support in care.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"6 2","pages":"119-128"},"PeriodicalIF":0.0,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9608691/pdf/jammi-2020-0042.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40451673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a provincial interactive antibiogram tool for Ontario.","authors":"Jennifer Lo,&nbsp;Bradley J Langford,&nbsp;Valerie Leung,&nbsp;Rita Ha,&nbsp;Julie Hui-Chih Wu,&nbsp;Samir N Patel,&nbsp;Sameer Elsayed,&nbsp;Nick Daneman,&nbsp;Kevin L Schwartz,&nbsp;Gary Garber","doi":"10.3138/jammi-2020-0010","DOIUrl":"https://doi.org/10.3138/jammi-2020-0010","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance (AMR) is a public health issue with significant impact on health care. Antibiogram development and deployment is a key strategy for managing and preventing AMR. Our objective was to develop an Ontario antibiogram as part of a larger provincial initiative aimed at advancing antimicrobial stewardship in the province.</p><p><strong>Methods: </strong>As part of a voluntary provincial online survey, antibiogram data from 100 of 201 (49.8%) Ontario hospitals were collected and included. All hospitals in Ontario were eligible to participate except those providing only mental health or ambulatory services. Weighted provincial and regional antibiotic susceptibilities (percentages) were conducted using descriptive statistical analyses, and an interactive antibiogram spreadsheet was developed. Respondent-identified barriers to collecting and interpreting antibiogram data are presented descriptively.</p><p><strong>Results: </strong>There was wide regional variability in antimicrobial-resistant organisms across Ontario. Provincial methicillin-resistant <i>Staphylococcus aureus</i> prevalence was 24.6%, ranging from 5.9% to 43.7% regionally. Provincial <i>Escherichia coli</i> resistance to ceftriaxone and ciprofloxacin was 13.8% (regional range 6.0%-25.1%) and 22.5% (regional range 9.8-37.8%), respectively. <i>Klebsiella</i> spp resistance to ceftriaxone and ciprofloxacin was similar across all health regions, with overall provincial rates of 7.5% and 5.6%, respectively.</p><p><strong>Conclusions: </strong>We have demonstrated that integrating hospital AMR tracking and reporting as part of a larger voluntary provincial antimicrobial stewardship program initiative is a feasible approach to capturing AMR data. The provincial antibiogram serves as a benchmark for the current state of AMR provincially and across health regions.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"6 2","pages":"129-136"},"PeriodicalIF":0.0,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9608690/pdf/jammi-2020-0010.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40451674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"β-lactam exposure outcome among patients with a documented allergy to penicillins post-implementation of a new electronic medical record system and alerting rules.","authors":"Brittany Buffone,&nbsp;Yu-Chen Lin,&nbsp;Jennifer Grant","doi":"10.3138/jammi-2020-0050","DOIUrl":"https://doi.org/10.3138/jammi-2020-0050","url":null,"abstract":"<p><strong>Background: </strong>Recent studies suggest that type I hypersensitivity cross-reactivity between β-lactam antibiotics is due to side chain similarity and not the common β-lactam ring. As a result, the prescriber-alerting rules of an electronic medical record (EMR) system were adjusted to only flag prescribers when prescribing penicillins or β-lactams with similar side chains (viz, cephalexin, cefadroxil, and cefoxitin) to patients with a documented allergy to penicillins. This study was conducted to assess and confirm the safety of the adjusted alerting rules; the primary outcome was the prevalence of anaphylaxis on β-lactam re-exposure.</p><p><strong>Methods: </strong>Retrospective chart review was conducted for patients who, under the reformed alerting rules, received a β-lactam antibiotic post-documentation of an allergy to penicillins in their EMR from April 2018 to July 2019 at a 268-bed community hospital. Given the volume of eligible patients, a 25% sample was randomly selected for review from initiation of the β-lactam antibiotic up to 30 days post-exposure to determine the prevalence of anaphylaxis.</p><p><strong>Results: </strong>Of the 325 charts reviewed, 300 patients (92.3%) received a β-lactam antibiotic with a different side chain than penicillins (not alerted on prescribing). Chart review of these 300 patients confirmed no reports of anaphylaxis secondary to β-lactam exposure (0%), and two patients developed non-anaphylactic delayed reactions (rash).</p><p><strong>Conclusions: </strong>There were no reports of immediate life-threatening anaphylaxis under the reformed alerting rules, despite 25 patients (7.7%) receiving an alerted drug, such as piperacillin-tazobactam. The reformed alerting rules better reflect current literature and reduce the risk of prescriber-alerting fatigue without compromising patient safety. The occurrence of delayed reactions reinforced the need to monitor for these reactions on β-lactam antibiotic prescribing.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"6 2","pages":"104-113"},"PeriodicalIF":0.0,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9608696/pdf/jammi-2020-0050.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40451670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atypical presentation of right-sided native valve infective endocarditis.","authors":"Daniel Doyle,&nbsp;Raynell Lang,&nbsp;Oscar E Larios","doi":"10.3138/jammi-2020-0033","DOIUrl":"https://doi.org/10.3138/jammi-2020-0033","url":null,"abstract":"<p><p>A previously healthy 55-year-old man presented to hospital with 10 days of progressive dyspnea with fever, night sweats, and a productive cough and no history of recreational drug use or occupational or animal exposures. His wife had developed similar symptoms 2 weeks earlier but had since recovered. Physical exam revealed a new systolic murmur best heard at the left lower sternal border. Transesophageal echocardiogram demonstrated severe tricuspid regurgitation with a small vegetation. Blood cultures were positive for non-typeable <i>Haemophilus influenzae</i>. This case illustrates the necessity of both timely and proficient diagnosis of <i>H. influenzae</i> infection and the unique challenges associated with detecting <i>H. influenzae</i>-related pathology. Clinicians should be aware of the variable presentations of <i>Haemophilus</i> infection, including respiratory infection, neurological infection, and infective endocarditis. Given the fastidious nature of <i>H. influenzae</i> and variability between subtype pathogenicity, microbiology laboratories require tools to culture and differentiate <i>Haemophilus</i> species.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"6 2","pages":"163-167"},"PeriodicalIF":0.0,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9608695/pdf/jammi-2020-0033.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40451672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and demographic predictors of antiretroviral efficacy in HIV-HBV co-infected patients.","authors":"Urvi Rana,&nbsp;Matt Driedger,&nbsp;Paul Sereda,&nbsp;Shenyi Pan,&nbsp;Erin Ding,&nbsp;Alex Wong,&nbsp;Sharon Walmsley,&nbsp;Marina Klein,&nbsp;Deborah Kelly,&nbsp;Mona Loutfy,&nbsp;Rejean Thomas,&nbsp;Stephen Sanche,&nbsp;Abigail Kroch,&nbsp;Nima Machouf,&nbsp;Marie-Héléne Roy-Gagnon,&nbsp;Robert Hogg,&nbsp;Curtis L Cooper","doi":"10.3138/jammi-2020-0011","DOIUrl":"https://doi.org/10.3138/jammi-2020-0011","url":null,"abstract":"<p><strong>Background: </strong>The clinical and demographic characteristics that predict antiretroviral efficacy among patients co-infected with HIV and hepatitis B virus (HBV) remain poorly defined. We evaluated HIV virological suppression and rebound in a cohort of HIV-HBV co-infected patients initiated on antiretroviral therapy.</p><p><strong>Methods: </strong>A retrospective cohort analysis was performed with Canadian Observation Cohort Collaboration data. Cox proportional hazards models were used to determine the factors associated with time to virological suppression and time to virological rebound.</p><p><strong>Results: </strong>HBV status was available for 2,419 participants. A total of 8% were HBV co-infected, of whom 95% achieved virological suppression. After virological suppression, 29% of HIV-HBV co-infected participants experienced HIV virological rebound. HBV co-infection itself did not predict virological suppression or rebound risk. The rate of virological suppression was lower among patients with a history of injection drug use or baseline CD4 cell counts of <199 cells per cubic millimetre. Low baseline HIV RNA and men-who-have-sex-with-men status were significantly associated with a higher rate of virological suppression. Injection drug use and non-White race predicted viral rebound.</p><p><strong>Conclusions: </strong>HBV co-infected HIV patients achieve similar antiretroviral outcomes as those living with HIV mono-infection. Equitable treatment outcomes may be approached by targeting resources to key subpopulations living with HIV-HBV co-infection.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"6 2","pages":"137-148"},"PeriodicalIF":0.0,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9608701/pdf/jammi-2020-0011.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40451675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appropriateness of antibiotic use in community hospitals in rural Newfoundland and Labrador.","authors":"Evan D Wheeler,&nbsp;Gerry McDonald,&nbsp;Peter Daley","doi":"10.3138/jammi-2020-0041","DOIUrl":"https://doi.org/10.3138/jammi-2020-0041","url":null,"abstract":"<p><strong>Background: </strong>Surveillance of the appropriateness of antimicrobial prescribing can identify targets for quality improvement in antimicrobial stewardship. Our objective was to measure antibiotic prescription prevalence, indication, and appropriateness at three rural community hospitals in a 1-day point prevalence study.</p><p><strong>Methods: </strong>Inpatient antibiotic prescriptions given at three community hospitals on April 24, 2019 were provided by the hospital pharmacies. These prescriptions were analyzed using the Australian National Antimicrobial Prescribing Survey (NAPS) tool. Prescriptions were assessed by an infectious diseases physician and analyzed per prescription.</p><p><strong>Results: </strong>Eighty prescriptions given to 58 inpatients were included. Antibiotic treatment prevalence was 58/120 beds (48.3%), and overall appropriateness was 37/80 prescriptions (46.3%). The most prescribed antibiotics were ceftriaxone (17 [21.3%]; 47.1% appropriate), piperacillin-tazobactam (10 [12.5%]; 10.0% appropriate), and moxifloxacin (9 [11.3%]; 0% appropriate). The most common indications were respiratory tract infections (36 [45.0%]; 36.1% appropriate), skin and soft tissue infections (14 [17.5%]; 78.6% appropriate), and urinary tract infections (9 [11.3%]; 11.1% appropriate). Of the 80 prescriptions, 50 (62.5%) documented an indication, and 71 (88.8%) documented a stop or review date.</p><p><strong>Conclusions: </strong>We observed a high treatment prevalence and low appropriateness. Overall appropriateness was lower than in urban hospitals.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"6 2","pages":"114-118"},"PeriodicalIF":0.0,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9608699/pdf/jammi-2020-0041.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40449680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 42-year-old man with nodular skin lesions.","authors":"Majid Darraj,&nbsp;Andrew Walkty,&nbsp;John Toole,&nbsp;Thomas Marrie,&nbsp;Leah Huzel,&nbsp;John M Embil","doi":"10.3138/jammi-2020-0051","DOIUrl":"https://doi.org/10.3138/jammi-2020-0051","url":null,"abstract":"<p><p>Nodular skin lesions are infrequently reported among patients with syphilis. We describe a 42-year-old man with secondary syphilis who presented with a nodular cutaneous eruption involving his neck, upper chest, back, arms, and legs. Because there was uncertainty regarding the diagnosis at presentation, the patient underwent a punch biopsy of one of the lesions. Spirochetes were not seen with a Steiner silver stain, but they were visualized on subsequent immunohistochemical staining. The diagnosis was confirmed with serology, and the patient responded well to treatment with benzathine penicillin G. Given the current increase in syphilis cases across North America, it is critical that clinicians become familiar with some of the less common dermatologic manifestations of this infection so that the diagnosis is entertained and appropriate serologic testing is ordered in a timely fashion.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"6 2","pages":"168-172"},"PeriodicalIF":0.0,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9608693/pdf/jammi-2020-0051.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40449682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-operative testing and personal protective equipment in the operating room during a pandemic: A survey of Ontario general surgeons.","authors":"Christopher D Griffiths,&nbsp;Dominik Mertz,&nbsp;Pablo E Serrano","doi":"10.3138/jammi-2020-0031","DOIUrl":"https://doi.org/10.3138/jammi-2020-0031","url":null,"abstract":"<p><strong>Background: </strong>The coronavirus disease 2019 (COVID-19) pandemic has had major implications for general surgery practice. We sought to characterize general surgeons' perceptions of their surgical practice in Ontario, Canada, regarding operating room precautions to maximize safety during the pandemic.</p><p><strong>Methods: </strong>A web-administered cross-sectional survey was sent to general surgeons registered with the College of Physicians and Surgeons of Ontario on May 19, 2020. Surgeons were surveyed regarding their practices in pre-operative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing, use of intra-operative personal protective equipment (PPE) given a patient's COVID-19 status, and management of common general surgical emergencies with COVID-19 patients. Responses were compared between surgeons from high- and low-prevalence public health units (PHUs) in Ontario using chi-square tests.</p><p><strong>Results: </strong>There were 81 respondents (rate: 81/271, 30%), 48 (59%) of whom were from a PHU in the top quartile of COVID-19 prevalence. Surgeons from low-prevalence PHUs reported pre-procedural COVID-19 testing rates similar to those reported in high-prevalence PHUs for elective (36% versus 55%), urgent (36% versus 54%), and emergent (20% versus 33%) surgeries. Seventy-eight percent of surgeons with COVID-19-negative patients limited trainees in the operating room compared with 96% of surgeons with COVID-19-positive patients. Use of N95 respirators was 17% for surgeons with COVID-19-negative patients, which dramatically increased to 62% for surgeons with patients whose COVID-19 status was unknown.</p><p><strong>Conclusions: </strong>These findings support a need for improved understanding of local disease prevalence and risk of COVID-19 transmission to conserve PPE and return surgical trainees to pre-pandemic standards.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"6 1","pages":"23-31"},"PeriodicalIF":0.0,"publicationDate":"2021-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9612436/pdf/jammi-2020-0031.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40669960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Gemella morbillorum</i> endocarditis and osteomyelitis in a patient with ankylosing spondylitis.","authors":"Zachary Singer,&nbsp;Benjamin Leis,&nbsp;Shravankumar Nosib,&nbsp;Siddharth Kogilwaimath","doi":"10.3138/jammi-2020-0032","DOIUrl":"https://doi.org/10.3138/jammi-2020-0032","url":null,"abstract":"<p><p>We report a rare case of <i>Gemella morbillorum</i> endocarditis of the native aortic and mitral valves, and native vertebral osteomyelitis, in a 49-year-old male with HLA-B27 negative ankylosing spondylitis (AKS). <i>G. morbillorum</i> is a rare cause of endocarditis; the incidence of which is unknown. AKS may predispose patients to endocarditis through chronic valvulitis. <i>G. morbillorum</i> bacteremia in patients with AKS should prompt consideration of infective endocarditis and a search for possible portals of entry.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"6 1","pages":"69-72"},"PeriodicalIF":0.0,"publicationDate":"2021-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9612437/pdf/jammi-2020-0032.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40669962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and evaluation of a primary care antimicrobial stewardship program (PC-ASP) in Toronto, Ontario, Canada.","authors":"Warren J McIsaac,&nbsp;Arrani Senthinathan,&nbsp;Rahim Moineddin,&nbsp;Yoshiko Nakamachi,&nbsp;Linda Dresser,&nbsp;Mark McIntyre,&nbsp;Suzanne Singh,&nbsp;Nelia De Oliveira,&nbsp;David Tannenbaum,&nbsp;Jeff Bloom,&nbsp;Camille Lemieux,&nbsp;Patricia Marr,&nbsp;Michelle Levy,&nbsp;Mira Mitri,&nbsp;Sakina Walji,&nbsp;Sahana Kukan,&nbsp;Andrew M Morris","doi":"10.3138/jammi-2020-0021","DOIUrl":"https://doi.org/10.3138/jammi-2020-0021","url":null,"abstract":"<p><strong>Background: </strong>Effective community-based antimicrobial stewardship programs (ASPs) are needed because 90% of antimicrobials are prescribed in the community. A primary care ASP (PC-ASP) was evaluated for its effectiveness in lowering antibiotic prescriptions for six common infections.</p><p><strong>Methods: </strong>A multi-faceted educational program was assessed using a before-and-after design in four primary care clinics from 2015 through 2017. The primary outcome was the difference between control and intervention clinics in total antibiotic prescriptions for six common infections before and after the intervention. Secondary outcomes included changes in condition-specific antibiotic use, delayed antibiotic prescriptions, prescriptions exceeding 7 days duration, use of recommended antibiotics, and emergency department visits or hospitalizations within 30 days. Multi-method models adjusting for demographics, case mix, and clustering by physician were used to estimate treatment effects.</p><p><strong>Results: </strong>Total antibiotic prescriptions in control and intervention clinics did not differ (difference in differences = 1.7%; 95% CI -12.5% to 15.9%), nor did use of delayed prescriptions (-5.2%; 95% CI -24.2% to 13.8%). Prescriptions for longer than 7 days were significantly reduced (-21.3%; 95% CI -42.5% to -0.1%). However, only 781 of 1,777 encounters (44.0%) involved providers who completed the ASP education. Where providers completed the education, delayed prescriptions increased 17.7% (<i>p</i> = 0.06), and prescriptions exceeding 7 days duration declined (-27%; 95% CI -48.3% to -5.6%). Subsequent emergency department visits and hospitalizations did not increase.</p><p><strong>Conclusions: </strong>PC-ASP effectiveness on antibiotic use was variable. Shorter prescription durations and increased use of delayed prescriptions were adopted by engaged primary care providers.</p>","PeriodicalId":36782,"journal":{"name":"JAMMI","volume":"6 1","pages":"32-48"},"PeriodicalIF":0.0,"publicationDate":"2021-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9612432/pdf/jammi-2020-0021.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40684775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}