SHM Converge Scientific Abstract ePoster Gallery-Decision-Making on Antibiotic Duration for Patients in Rural Settings

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This survey study examined whether hospitalists choose longer antibiotic courses for hospitalized patients with community-acquired pneumonia when follow-up is uncertain because the patient lives in a rural area.<br /><br />A single academic medical center surveyed hospitalists in November 2019 using a clinical vignette. The vignette described a 64-year-old man treated for presumed CAP who had improved clinically and wanted discharge, but still had some abnormal findings. Respondents were randomized to receive one of two social-context details: either the patient lived locally with follow-up already arranged, or he lived six hours away with limited access to care and delayed primary care follow-up. Clinicians were then asked what discharge antibiotic duration they would prescribe. The study compared guideline-concordant 5-day treatment with excess durations of 7 or 10 days.<br /><br />Seventy percent of hospitalists responded (71/102). Hospitalists were significantly more likely to choose excess antibiotic duration for the rural scenario than for the local scenario: 37% (11/29) versus 10% (4/42), p=0.004. In the rural case, more clinicians selected longer courses, suggesting concern that extended therapy might be protective when follow-up access is poor.<br /><br />The authors conclude that clinician concern about access to care may contribute to antibiotic overuse for rural patients. They suggest that better discharge planning, including tele-follow-up, could reduce unnecessary prolonged antibiotic prescribing. One limitation was that the vignette did not offer the option to keep the patient hospitalized, which some clinicians might prefer instead of extending antibiotics.

Asset Subtitle

Guinn Dunn

Meta Tag

Author List Adamo Brancaccio, Daniel Giesler, Daraoun Mashrah, Guinn Dunn, Jennifer K. Horowitz, Julia E. Szymczak, Valerie M. Vaughn

Category Research

Concept Community-Acquired Pneumonia

Concept Antibiotic Duration

Concept Overuse

Concept Antimicrobial Stewardship

Concept Hospitalization

Distinguished Non-Finalist

Presenter Organization University of Utah Department of Internal Medicine

Presenting Author Guinn Dunn

Track Transitions of Care

Keywords

community-acquired pneumonia

hospitalists

antibiotic duration

rural patients

follow-up access

clinical vignette

antibiotic overuse

discharge planning

tele-follow-up

guideline-concordant treatment

Community-Acquired Pneumonia

Antibiotic Duration

Overuse

Antimicrobial Stewardship

Hospitalization