A Unique Collaboration with Primary Care Pediatricians to Optimize Topics & Tools for Outpatient Antimicrobial Stewardship
Authors: Taylor Margaret , Quan Dan , Stimes Grant , Rodriguez Brittany , Palazzi Debra 
Published: January 2025

Abstract

Corresponding author: Margaret Taylor MD, Baylor College of Medicine, Department of Pediatrics, Division of Infectious Diseases, Feigin Center, 1102 Bates Ave, Suite 1150, Houston, TX 77030. mgtaylor@bcm.edu. 832-824-1780.
Alternate corresponding author: Debra Palazzi MD, MEd, Baylor College of Medicine, Department of Pediatrics, Division of Infectious Diseases, Feigin Center, 1102 Bates Ave, Suite 1150, Houston, TX 77030. dpalazzi@bcm.edu. 832-824-1786.
Funding sources: Margaret Taylor & Debra Palazzi receive grant-funding support from Pew Charitable Trusts as part of an initiative to support antimicrobial stewardship associated with Texas Children’s Health Plan.
No conflicts of interest.

Background
Expansion of antimicrobial stewardship programs (ASPs) into ambulatory settings is a priority for many academic institutions. Educational series, quality improvement projects, and clinical decision support tools have been used to improve antimicrobial use. We describe a unique collaboration with primary care providers (PCPs) in the ambulatory setting to optimize ASP education and tools.

Methods
A survey designed to 1) identify key topics for outpatient antimicrobial stewardship activities, 2) list barriers to stewardship, and 3) recruit primary care providers interested in joining a multi-disciplinary ASP team was sent to primary care and urgent care providers at Texas Children’s Pediatrics (TCP) and Texas Children’s Urgent Care (TCUC) in December 2023. Following the results of this survey, a core ASP team of ambulatory care providers, infectious diseases faculty, and pharmacists was formed to develop further ASP activities.

Results
Seventy-six primary care and urgent care pediatricians and advanced practitioners across Houston, College Station, and Austin, TX responded to the outpatient ASP survey. The ASP activities rated most beneficial were an outpatient penicillin allergy de-labeling clinic, activities for CME or MOC, and clinical decision support tools. Top education priorities included management of recurrent streptococcal pharyngitis and treatment of bacterial respiratory tract infections in children with and without penicillin allergies. Nine clinicians volunteered to join a multidisciplinary committee. During initial outpatient ASP team sessions, feedback on ASP ideas and recommendations for future activities were discussed (Table 1).

Conclusion
A multidisciplinary outpatient team identified ASP efforts in the ambulatory setting considered most important by providers. Top priorities include distribution of an outpatient ASP handbook, creation of educational modules, creation of an accessible ASP dashboard, incorporation of ASP activities into existing monthly newsletters and quality committees, and tools for family engagement. Future work will focus on adapting these recommendations and continuing to survey physicians on priorities and wishes for outpatient ASP.
Table 1. Feedback on Proposed Outpatient Antimicrobial Stewardship Activities.