In the Journals Plus

Telehealth promotes antimicrobial stewardship in rural settings

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September 16, 2018

Researchers tested the feasibility of using telehealth to promote antimicrobial stewardship at two rural Veterans Affairs medical centers, or VAMCs, with limited access to infectious disease specialists and found it to be feasible, according study results published in Infection Control & Hospital Epidemiology.

“The threats posed by antimicrobial resistance have led to strong recommendations and regulatory actions,” Lauren D. Stevenson, PhD, researcher at the Louis Stokes Cleveland VA Medical Center, and colleagues wrote. “The number of trained infectious disease physicians and pharmacists is insufficient to meet the urgent need for comprehensive antimicrobial stewardship programs across health care settings, including the Veterans Health Administration, the largest integrated health care system in the United States.”

According to Stevenson and colleagues, a 2012 survey found that 40% of VAMCs providing inpatient care did not have a full-time ID physician on staff, leaving the implementation of antimicrobial stewardship programs to physicians, pharmacists and nurses who lack training in infectious disease or antimicrobial stewardship.

For the study, they developed a pilot telehealth project that used videoconferencing to connect pharmacists, infection preventionists, staff nurses and other clinicians at rural VAMCs with ID physicians, creating a remote antimicrobial stewardship team.

To test its efficacy, Stevenson and colleagues implemented the system at two unnamed rural VAMCs. Site A, with 27 acute-care beds and 162 long-term care beds, started using it in August 2016. Site B, with 10 acute-care and 180 long-term care beds, began in October 2016. Each week, staff at both sites selected cases for discussion at the weekly telehealth videoconference, according to Stevenson and colleagues. During the 1-hour meetings, cases were presented and discussed, and the team made recommendations for treatment.

Over the 1-year period, the team at Site A discussed 140 cases in 40 sessions and Site B discussed 119 cases in 38 sessions, the researchers reported. According to the study, the most common recommendation at both sites was to stop antibiotics — a recommendation that had an 82% acceptance rate at Site A and 71% acceptance rate at Site B. Participants reported that some providers were not open to recommendations to change treatment plans, which they attributed to ego or being “set in their ways,” Stevenson and colleagues said.

However, they noted that, overall, participants reported that telehealth sessions increased their awareness of antibiotics stewardship principles which helped them adapt their practice patterns and engage in antimicrobial stewardship efforts.

“The VA has successfully used telemedicine to increase veterans’ access to specialty care providers,” they concluded. “This program is an effective health care delivery model that integrates patient care with provider education, improving access to specialty care from a distance.” – by Caitlyn Stulpin

Disclosures: The authors report no relevant financial disclosures.