To evaluate the impact of a stewardship program on systemic glucocorticoid prescribing for acute respiratory infections in urgent care settings, addressing the urgent need to reduce inappropriate prescribing.
Key Findings:
Mean clinician-level prescribing rates declined from 20.4 to 8.8 prescriptions per 100 stewardship-eligible visits, significantly lower than the national average of approximately 11% for outpatient respiratory infection visits.
Interpretation:
The stewardship program led to a gradual decrease in glucocorticoid prescribing, indicating a significant behavioral shift among clinicians towards more appropriate prescribing practices.
Limitations:
Study was not randomized and lacked a control group, limiting causal interpretation.
Changes in clinician coding practices may have affected the denominator of stewardship-eligible visits, potentially overstating the improvement.
Unintended consequences of reduced glucocorticoid prescribing, such as return visits or patient satisfaction, were not systematically assessed.
Conclusion:
Further research is essential to determine the generalizability and effectiveness of such interventions in diverse settings and for other medications.
Higher annual oral corticosteroid exposure was associated with greater odds of systemic adverse events, with avascular bone necrosis and pneumonia showing dose-dependent associations with cumulative dose and osteoporosis associated with longer annual exposure duration.
