Knowledge and Perspectives of Antimicrobial Stewardship: A Comparison of Inpatient vs. Outpatient Providers

Abstract Background There is increasing knowledge of antimicrobial stewardship (AS) among inpatient (IP) healthcare providers (HCP), but this is less clear for the outpatient (OP) setting. Recent studies suggest 30% of antibiotics prescribed in the OP are unnecessary and should be a focus of future AS efforts. We surveyed HCP within our healthcare system on AS to compare the practices and perspectives between the IP and OP providers. Methods HCP in Rochester Regional Health were sent an 11-item electronic survey on AS. Fisher’s exact test and Z test were used to assess for differences between the IP and OP responses. Results A total of 378 HCP completed the survey: 227 attending physicians, 40 residents in training, 102 advanced practice providers, and 9 pharmacists. Overall, 153 (40%) self-identified as IP and 225 (60%) as OP. Antibiotic prescribing on a daily or a more than once daily basis was common, although significantly more so for the IP group (59% vs. 42%, P < 0.01). Significantly more OP HCP ranked treatment of sinusitis/pharyngitis/bronchitis in the 3 most common reasons for prescribing antibiotics (48% vs. 9%, P < 0.01). Recognition of pharmacists and local antibiograms as prescribing resources was significantly lower among OP HCP (15% vs. 41%, P < 0.01 and 37% vs. 56%, P = 0.03, respectively). OP HCP were more likely to prescribe antibiotics for patient satisfaction (13% vs. 6%, P = 0.03), but IP HCP were more likely to prescribe when unsure of a bacterial infection (65% vs. 50%, P < 0.01). Both groups similarly agreed that antibiotic resistance is a serious public health concern, is caused by antibiotic overuse, and that antibiotics are overprescribed in their local areas. However, despite significantly more OP than IP agreeing that AS was something that they can do (80% vs. 67%, P < 0.01), 12% of OP reported not hearing of AS and 21% reported not having access to AS resources. Conclusion Antibiotic prescribing is frequent in the OP setting. While OP HCP acknowledge the problems of antibiotic overuse and most report they practice AS, many continue to prescribe antibiotics inappropriately. Increased knowledge of treatment guidelines and access to pharmacy and antibiograms may alleviate this discordance between the understanding and application of AS in the OP setting. Disclosures All authors: No reported disclosures.