In the JournalsPerspective

Implementing ASP via telehealth represents a ‘viable’ strategy

Nathan R. Shively, MD,
Nathan R. Shively

An antimicrobial stewardship program implemented via telehealth at a community hospital in western Pennsylvania decreased broad-spectrum antibiotic use, increased infectious diseases consultations and lowered costs associated with antimicrobial therapy.

“Community hospitals, despite having antimicrobial utilization similar to that of larger hospitals, often have fewer resources, less access to infectious diseases (ID) expertise and are less likely to have formal [antimicrobial stewardship programs (ASPs)] that meet all of the CDC’s Core Elements,” Nathan R. Shively, MD, medical director of the antimicrobial stewardship program at Allegheny Valley Hospital, and colleagues wrote. “Support via telehealth represents a potential solution, which is endorsed by the Infectious Diseases Society of America (IDSA), and telehealth staff are acceptable members of the ASP team, per regulatory guidelines.”

However, the study noted that limited data are available in regard to telehealth-based ASPs in the community hospital setting.

Shively and colleagues put telehealth-based ASPs into place at two community hospitals. Local pharmacists were trained to carry out prospective audit and feedback. In conjunction with the pharmacists, ID physicians remotely reviewed patients who were receiving broad-spectrum antibiotics and those with lower respiratory tract infections and skin and soft tissue infections up to three times a week. For a 12-month baseline period and the 6-month intervention period, antimicrobial use was categorized in days of therapy (DOT) per 1,000 patient-days (1,000 PD).

“We think the program we described would represent a viable solution for many hospitals. However, although the program was facilitated via telehealth, the geographic proximity of the institutions did allow for some occasional on-site presence of the infectious diseases physicians responsible for the program to meet with on-site pharmacists and clinicians,” Shively told Infectious Disease News. “Thus, generalizability could be limited to institutions that are more geographically remote.”

According to the study, 1,419 recommendations were made during the intervention period, with an 88.9% acceptance rate. During the intervention period, broad-spectrum antibiotic use decreased by 24.4% (342.1 vs. 258.7 DOT/1,000 PD; P < .001) and ID consultations increased by 40.2% compared with baseline (P = .001).

Moreover, the researchers estimated an annual savings of $142,629.83 on antimicrobial expenditures.

“Establishing a robust, successful antimicrobial stewardship program is possible at small community hospitals and telehealth may be an excellent way to help facilitate this,” Shively said. “Our study highlights one approach by which small hospitals may gain access to such expertise via telehealth and a way for larger institutions with established antimicrobial stewardship programs to be part of the solution for other centers.” – by Marley Ghizzone

Disclosures: Shively reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Nathan R. Shively, MD,
Nathan R. Shively

An antimicrobial stewardship program implemented via telehealth at a community hospital in western Pennsylvania decreased broad-spectrum antibiotic use, increased infectious diseases consultations and lowered costs associated with antimicrobial therapy.

“Community hospitals, despite having antimicrobial utilization similar to that of larger hospitals, often have fewer resources, less access to infectious diseases (ID) expertise and are less likely to have formal [antimicrobial stewardship programs (ASPs)] that meet all of the CDC’s Core Elements,” Nathan R. Shively, MD, medical director of the antimicrobial stewardship program at Allegheny Valley Hospital, and colleagues wrote. “Support via telehealth represents a potential solution, which is endorsed by the Infectious Diseases Society of America (IDSA), and telehealth staff are acceptable members of the ASP team, per regulatory guidelines.”

However, the study noted that limited data are available in regard to telehealth-based ASPs in the community hospital setting.

Shively and colleagues put telehealth-based ASPs into place at two community hospitals. Local pharmacists were trained to carry out prospective audit and feedback. In conjunction with the pharmacists, ID physicians remotely reviewed patients who were receiving broad-spectrum antibiotics and those with lower respiratory tract infections and skin and soft tissue infections up to three times a week. For a 12-month baseline period and the 6-month intervention period, antimicrobial use was categorized in days of therapy (DOT) per 1,000 patient-days (1,000 PD).

“We think the program we described would represent a viable solution for many hospitals. However, although the program was facilitated via telehealth, the geographic proximity of the institutions did allow for some occasional on-site presence of the infectious diseases physicians responsible for the program to meet with on-site pharmacists and clinicians,” Shively told Infectious Disease News. “Thus, generalizability could be limited to institutions that are more geographically remote.”

According to the study, 1,419 recommendations were made during the intervention period, with an 88.9% acceptance rate. During the intervention period, broad-spectrum antibiotic use decreased by 24.4% (342.1 vs. 258.7 DOT/1,000 PD; P < .001) and ID consultations increased by 40.2% compared with baseline (P = .001).

Moreover, the researchers estimated an annual savings of $142,629.83 on antimicrobial expenditures.

“Establishing a robust, successful antimicrobial stewardship program is possible at small community hospitals and telehealth may be an excellent way to help facilitate this,” Shively said. “Our study highlights one approach by which small hospitals may gain access to such expertise via telehealth and a way for larger institutions with established antimicrobial stewardship programs to be part of the solution for other centers.” – by Marley Ghizzone

Disclosures: Shively reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

    Perspective
    Javeed Siddiqui

    Javeed Siddiqui

    Telehealth, at its very essence, is a workforce multiplier. The study by Shively and colleagues exemplifies this concept. The basis of the paper is the use of telemedicine to expand access to ID physician-directed ASPs at two community-based hospitals

    that otherwise would not have had such a comprehensive program.

    Telehealth allowed these community hospitals to implement and operate a comprehensive ASP that meets the core elements set forth by the CDC. These programs were led by experienced ID physicians who were able to connect with the onsite pharmacist on a regular basis through telehealth technologies and be able to oversee perspective audits, attend ASP committee meetings and do the daily work that is essential to a successful stewardship program.

    Telehealth allowed for the elimination of geographic barriers and served as an effective tool to increase access to needed medical expertise.

    One conclusion not specifically addressed by the authors, but rather implied, was that a telehealth-based ASP was able to function with a depth and breadth similar to that of a brick-and-mortar ASP.

    The importance of this study is that it continues to add to a growing volume of literature illustrating the practicality and the success of telehealth-based ASPs.

    In addition, the authors were able to demonstrate an increase in use of ID consultative services, which is an important metric due to the unsubstantiated belief that a successful ASP results in a decreased request for consultative services.

    The cost savings of this program further illustrate that telehealth should not be considered as a secondary option but rather an essential tool to enhance the use of ID physician-led ASPs.

    The data presented in this study should be a wake-up call to hospitals of any size, be they critical access hospitals or large-scale community medical centers, that they, too, have the ability to access comprehensive ID physician-led antimicrobial stewardship programs through the implementation of telehealth technologies.

    • Javeed Siddiqui, MD, MPH
    • Co-founder and chief medical officer
      TeleMed2U
      Member, Infectious Diseases Society of America

    Disclosures: Siddiqui is the co-founder and chief medical officer of TeleMed2U, a telemedicine-based practice.