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.
