VA study finds expectation of antibiotics colors patient satisfaction

A study of Veterans Affairs (VA) patients found that the expectation of an antibiotic had a bigger impact on patient satisfaction than did receipt of an antibiotic, researchers reported today in Antimicrobial Stewardship & Healthcare Epidemiology.

For the cross-sectional study, researchers from the Veterans Health Administration and Vanderbilt University Medical Center evaluated electronic medical record data and patient satisfaction questionnaires completed by veterans who were treated for an upper respiratory infection (URI) in an 18-clinic ambulatory VA primary care system.

Previous research has shown that unnecessary antibiotic prescribing for URIs is common in VA patients, and one partial explanation is that many VA healthcare providers perceive that their patients expect antibiotics and will base their satisfaction with the visit on whether or not they get them. But that hypothesis has not previously been tested.

Of the 1,329 veterans eligible for the study, 432 completed the questionnaires, for a response rate of 33%. Of those patients, 228 (52.8%) received an antibiotic and 204 (47.2%) did not. Analysis of the questionnaires found no difference in mean total satisfaction for those who received an antibiotic (67.7 points) versus those who did not (66.9 points) (adjusted difference, 0.6 points; 95% confidence interval [CI], –2.1 to 3.3). But for those who expected an antibiotic compared with those who did not, the mean total satisfaction score was 4.4 points lower (95% CI, –7.3 to –1.6 points). And among the veterans who accurately remembered the visit and did not receive an antibiotic, those who expected an antibiotic had significantly lower satisfaction scores than those who did not (unadjusted score difference, –16.6; 95% CI, –24.6 to –8.6).

"In conclusion, antibiotic receipt alone does not determine Veteran satisfaction with URI visits," the study authors write. "Patient expectations of receiving or not receiving an antibiotic were an important factor that significantly affected satisfaction scores."

The authors add that while the findings may not be generalizable to populations outside the VA system, they suggest that working with patients to understand what drives their expectations could inform efforts to reduce unnecessary antibiotic prescribing for URIs.
Jun 23 Antimicrob Steward Healthc Epidemiol study

Study suggests MRSA nasal swabs could play bigger stewardship role

A study conducted in a West Virginia hospital found that implementation of methicillin-resistant Staphylococcus aureus (MRSA) nasal swabs was associated with reduced use of gram-negative antibiotics, researchers reported today in the Journal of Antimicrobial Chemotherapy.

In the study, researchers with West Virginia University Hospitals conducted a retrospective chart review to compare the duration of gram-negative antibiotic therapy for pneumonia before and after the implementation of MRSA polymerase chain reaction (PCR) nasal swabs, which have previously been shown to be very accurate in ruling out MRSA pneumonia and limiting the use and duration of broad-spectrum anti-MRSA antibiotics. Although MRSA is a gram-positive bacterium, the researchers wanted to see if use of MRSA PCR nasal swabs might also have an impact on broad-spectrum gram-negative antibiotics by prompting discussions about appropriate empiric therapy and antibiotic de-escalation.

Comparing antibiotic use in 120 community- and hospital-acquired pneumonia patients pre-implementation and 120 post-implementation, the researchers found that the median duration of gram-negative therapy was 154 hours in post-implementation group and 176.4 hours in the pre-implementation group. There were no significant differences in the secondary outcomes of time to de-escalation (52.7 hours vs 54.9 hours) or time to transition from intravenous to enteral therapy (53 hours vs 57.3 hours). The median cost of gram-negative regimens per patient was nearly $15 lower in the post-implementation group ($31.36 vs $45.90).

The authors say the findings are noteworthy because shorter antibiotic durations not only reduce patient exposure to antibiotics and their potential side effects but can also shorten hospital stays.

"This introduces an additional benefit of MRSA nasal swabs and further incentivizes their use as an antimicrobial stewardship tool," they write.
Jun 23 J Antimicrob Chemother abstract