Telehealth boosts antimicrobial stewardship in pilot study

Businessman video-chats with doctor on laptop
A pilot study among VA hospitals showed that weekly hourlong check-ins helped rural doctors manage patients whose cases raised infectious disease concerns and improved antibiotic prescribing practices. (Getty/AndreyPopov)

Weekly videoconferencing check-ins have shown promise in improving antibiotic prescribing practices at rural facilities and may help improve continuity of care as well, a recently reported pilot study found.

Rising numbers of antibiotic-resistant infections have stakeholders across the healthcare industry seeking novel ways to encourage better stewardship among prescribers. Rural hospitals pose a unique difficulty in this regard since they frequently do not have consistent access to infectious disease physicians and pharmacists with expertise in good prescribing practices.

In a pilot study that paired infectious disease experts at VA hospitals with care teams located in rural facilities, researchers took a look at video conferencing as a viable means of training and ongoing support. The results were so positive the initial six-month study period was doubled to a year after participants requested that the program continue.

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Robin Jump, M.D., Ph.D., an associate director of informatics and analytics at the Geriatric Research, Education and Clinical Center Specialty Care Center of Innovation at the Louis Stokes Cleveland VA Medical Center, described the program’s approach as straightforward and hands-on.

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After about three hours of preparation time each week, she would meet for an hour with a care team at the VA hospital in Chillicothe, Ohio, to discuss patients whose cases raised infectious disease concerns. In that context, the team would discuss wise use of antibiotics for the veterans in their care, which could involve stopping antibiotics entirely or narrowing therapies as appropriate based on diagnostic tests or culture results.

Connecting in a collegial atmosphere to talk about antimicrobial stewardship in a practical way appeared to appeal to both rural providers and the expert physicians with whom they interact, according to Lauren Stevenson, Ph.D., the study’s lead author and a research health science specialist at the Louis Stokes Cleveland VA Medical Center. “A lot of the providers from the rural sites that were participating really enjoyed this and enjoyed having what they felt was expert input into these cases they had—and some of them were trickier for them, which is why they were asking for assistance,” she said.

Beyond incremental adjustments to treatments for individual patients, Jump also saw physicians become more assertive in their decision-making as time went on.

“For the most part, when we’re making recommendations to stop or to narrow therapy, the docs already want to make those choices and they just needed support or permission to do that,” she said. “What’s been really cool is that as we’ve gone on with this, instead of asking if it’s OK, now they come in and say, hey, I already did the narrowing or I already stopped this prescription—what do you think?”

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An additional cause for optimism about the approach came as a side effect of gathering the entire care team for the discussions: It allowed NPs and pharmacists from both settings to communicate and set antibiotic plans for the veterans. For residents moving between long-term and acute care settings, direct communication among team members can smooth care transitions, a vulnerable point for patients regardless of the healthcare system caring for them, Jump said.

The VA’s long experience with telehealth infrastructure based on the SCAN-ECHO program, combined with standard reimbursement policies used by the VA system, may make it easier to expand the program within the VA than without for now, but the need to bring antibiotic prescribing under control makes Jump hopeful that other systems will embrace the technology.

“I think we’re on the forefront of a growing area, and I think it will work in other places as well,” she said.