Pharmacist gender and physician acceptance of antibiotic stewardship recommendations: An analysis of the reducing overuse of antibiotics at discharge home intervention.

2022

1-8

06/2022

1559-6834

OBJECTIVE: To assess association of pharmacist gender with acceptance of antibiotic stewardship recommendations.

DESIGN: A retrospective evaluation of the Reducing Overuse of Antibiotics at Discharge (ROAD) Home intervention.

SETTING: The study was conducted from May to October 2019 in a single academic medical center.

PARTICIPANTS: The study included patients receiving antibiotics on a hospitalist service who were nearing discharge.

METHODS: During the intervention, clinical pharmacists (none who had specialist postgraduate infectious disease residency training) reviewed patients on antibiotics and led an antibiotic timeout (ie, structured conversation) prior to discharge to improve discharge antibiotic prescribing. We assessed the association of pharmacist gender with acceptance of timeout recommendations by hospitalists using logistic regression controlling for patient characteristics.

RESULTS: Over 6 months, pharmacists conducted 295 timeouts: 158 timeouts (53.6%) were conducted by 12 women, 137 (46.4%) were conducted by 8 men. Pharmacists recommended an antibiotic change in 82 timeouts (27.8%), of which 51 (62.2%) were accepted. Compared to male pharmacists, female pharmacists were less likely to recommend a discharge antibiotic change: 30 (19.0%) of 158 versus 52 (38.0%) of 137 (P < .001). Female pharmacists were also less likely to have a recommendation accepted: 10 (33.3%) of 30 versus 41 (8.8%) of 52 (P < .001). Thus, timeouts conducted by female versus male pharmacists were less likely to result in an antibiotic change: 10 (6.3%) of 158 versus 41 (29.9%) of 137 (P < .001). After adjustments, pharmacist gender remained significantly associated with whether recommended changes were accepted (adjusted odds ratio [aOR], 0.10; 95%confidence interval [CI], 0.03-0.36 for female versus male pharmacists).

CONCLUSIONS: Antibiotic stewardship recommendations made by female clinical pharmacists were less likely to be accepted by hospitalists. Gender bias may play a role in the acceptance of clinical pharmacist recommendations, which could affect patient care and outcomes.

10.1017/ice.2022.136

Infect Control Hosp Epidemiol

35670587

COVID-19 Research Agenda for Healthcare Epidemiology.

2021

1-81

2021 Jan 25

1559-6834

<p>This SHEA white paper identifies knowledge gaps and challenges in healthcare epidemiology research related to COVID-19 with a focus on core principles of healthcare epidemiology. These gaps, revealed during the worst phases of the COVID-19 pandemic, are described in 10 sections: epidemiology, outbreak investigation, surveillance, isolation precaution practices, personal protective equipment (PPE), environmental contamination and disinfection, drug and supply shortages, antimicrobial stewardship, healthcare personnel (HCP) occupational safety, and return to work policies. Each section highlights three critical healthcare epidemiology research questions with detailed description provided in supplemental materials. This research agenda calls for translational studies from laboratory-based basic science research to well-designed, large-scale studies and health outcomes research. Research gaps and challenges related to nursing homes and social disparities are included. Collaborations across various disciplines, expertise and across diverse geographic locations will be critical.</p>

10.1017/ice.2021.25

Infect Control Hosp Epidemiol

33487199

Addressing the Overuse of Cultures to Optimize Patient Care.

2019

S73-S74

2019 Oct 01

1539-3704

<p>Microbiological testing helps clinicians identify pathogens and optimize treatment. However, infection may be misdiagnosed when a “positive” culture represents colonization or contamination. Misdiagnosis of infection may delay correct diagnosis, prompt inappropriate antibiotic use, and result in patient harm. Diagnostic stewardship can improve the appropriate use of microbiological tests and cultures. As diagnostic tests have proliferated, our reliance on tests for diagnosis has increased, even as our knowledge of test characteristics has decreased. Consideration of the mental models that contribute to overtesting can help us identify strategies to combat the “culture of culturing.”</p>

10.7326/M18-3442

Ann. Intern. Med.

31569221