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1 Be Antibiotics Aware: Smart Use, Best Care Tuesday, November 14, :00 PM ET In Case of Technical Difficulties If you hear an echo: Make sure you are only logged in once on your computer Select one form of audio only (either computer speakers or telephone connection) If the audio is choppy: Press pause in the top left corner of your screen Wait 10 seconds and then click the play button Dial at any time for live assistance 1

2 Agenda Agenda Welcome and Introductions William Schaffner, MD NFID Medical Director Professor of Preventive Medicine and Infectious Diseases, Vanderbilt University School of Medicine Be Antibiotics Aware: Smart Use, Best Care Lauri A. Hicks, DO (CAPT, USPHS) Director, Office of Antibiotic Stewardship Medical Director, Get Smart: Know When Antibiotics Work Division of Healthcare Quality Promotion Centers for Disease Control and Prevention Questions and Answers This webinar is supported by an unrestricted educational grant from Merck & Co., Inc. NFID policies restrict funders from controlling program content. General Information Please note that today s webinar is being recorded All phone lines will be placed on mute throughout the program To hear audio: Computer: Follow directions Phone: ; Access Code After the presentations, there will be a Question and Answer period Use the Chat box on the lower left side of your screen to type your question At the end of the webinar, participants will be directed to an online evaluation Following the webinar, all registered participants will receive an with a link to the presentation slides 2

3 CME/CNE Credit & Webinar Evaluation The National Foundation for Infectious Diseases (NFID) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians. NFID designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit TM. This continuing nursing education activity was approved by the Ohio Nurses Association, an accredited approver by the American Nurses Credentialing Center s Commission on Accreditation (OBN ). This education activity has been approved for a maximum of 1.o contact hour. To receive credit or contact hours, you must complete the online evaluation and pass the post-test with a score of 80% or higher Online evaluation and post-test will be available following the webinar at: Certificate will be available for print or download following successful completion of online evaluation and post-test until November 14, Disclosures Marla Dalton (NFID staff, content reviewer) owns stock, stock options, patent, or other intellectual property from Merck & Co., Inc. William Schaffner (NFID medical director, presenter) served as an advisor or consultant for Dynavax, Merck & Co., Inc., Pfizer Inc., Seqirus, and SutroVax All other activity planners/reviewers and staff for this activity have no relevant financial relationships to disclose 3

4 Learning Objectives At the conclusion of this activity, participants will be able to: Discuss opportunities to improve antibiotic use in the United States Describe effective strategies to improve antibiotic prescribing and use Describe updated CDC educational efforts to improve antibiotic use About NFID Non-profit 501(c)(3) organization dedicated to educating the public and healthcare professionals about causes, prevention, and treatment of infectious diseases across the lifespan Reaches consumers, healthcare professionals, and media through: Coalition-building activities Public outreach initiatives Professional educational programs (ACCME accredited with commendation) Scientific meetings, research, and training Longstanding partnerships to facilitate rapid program initiation and increase programming impact Flexible and nimble organization 4

5 Be Antibiotics Aware: Smart Use, Best Care Lauri A. Hicks, DO (CAPT, USPHS) Director, Office of Antibiotic Stewardship Medical Director, Get Smart: Know When Antibiotics Work Division of Healthcare Quality Promotion Centers for Disease Control and Prevention Atlanta, GA Opportunities to Improve Antibiotic Use 5

6 What Is Antibiotic Stewardship? Antibiotic stewardship is the effort to: Measure antibiotic prescribing Improve antibiotic prescribing so that antibiotics are only prescribed and used when needed Minimize misdiagnoses or delayed diagnoses leading to underuse of antibiotics Ensure that the right drug, dose, and duration are selected when an antibiotic is needed It s about patient safety and delivering high-quality healthcare Have We Made Any Progress? antibiotic prescribing All ages: decreased 5% Pediatric: decreased 14% Adults: no change 0-19 years 20+ years of age 6

7 Highest state 1285 per 1000 Lowest state: 502 per 1000 US, 2014: 835 antibiotic courses per 1000 population Sweden, 2014: 328 antibiotic courses per 1000 population How Much Antibiotic Use Is Unnecessary In Outpatient Settings? Represents unnecessary risks to patients of adverse drug events, Clostridium difficile infection, and development of antibiotic resistance Fleming-Dutra et al. JAMA 2016;315(17):

8 Improving Outpatient Antibiotic Selection Among 3 most common diagnoses leading to antibiotics, 52% received first-line therapies Hersh et al. JAMA Int Med 2016;315(17): The Pew Charitable Trusts. May At least 80% should receive first-line therapy, accounting for allergies and treatment failures Truven MarketScan Health claims data Over half (55%) of patients received at least one antibiotic dose National prescribing rate: 755 days of therapy/1000 patientdays Increases in broad-spectrum antibiotics Increases recorded for 3 rd /4 th generation cephalosporins, macrolides, glycopeptides, β-lactam/β-lactamase inhibitor combinations, carbapenems, and tetracyclines No overall change in antibiotic use over the time period Baggs et al. JAMA Int Med

9 Measuring Antibiotic Use in Hospitals CDC launched the National Healthcare Safety Network Antimicrobial Use Option and created a benchmark measure of antibiotic use volume Appropriateness being assessed through the Emerging Infections Program hospital healthcare associated infections and antibiotic use survey in ~200 hospitals in 10 states CDC worked with The Pew Charitable Trusts and stewardship experts to identify key targets: Two agents: Vancomycin, Quinolones Two infections: Community acquired pneumonia, urinary tract infections What We Know about US Nursing Home Antibiotic Use Up to 70% of residents receive an antibiotic each year Estimate 40-75% of antibiotic use in inappropriate or unnecessary Lack national data What We Don t Know and Are Working to Address What s being used? For what indications? In what types of nursing home patients? 9

10 Practices and Programs to Improve Healthcare Provider Prescribing Improving Prescribing Requires Changing Behavior Education alone is not enough All settings Audit and feedback Clinical decision support Hospitals Restriction policies Antibiotic time-out Outpatient settings Delayed prescribing or watchful waiting. Communications training Commitment posters 10

11 Commitment Posters from Illinois, Texas, New York, and CDC Meeker et al. JAMA Intern Med. 2014;174(3): blogs.cdc.gov/safehealthcare/?p=5900 cdc.gov/getsmart/community/materials-references/print-materials/hcp/index.html Add your picture and signature here CDC s Core Elements of Antibiotic Stewardship: Hospitals, Critical Access Hospitals, Nursing Homes, Outpatient Settings

12 Health Insurers and The Joint Commission Increasing Uptake of CDC s Core Elements of Antibiotic Stewardship Anthem and Blue Cross/Blue Shield Quality-In-Sights Hospital Incentive Program (Q-HIP ) Developed a measure focused on implementation of comprehensive Antibiotic Stewardship program meeting CDC s Hospital Core Elements CMS Quality Innovation Network and Quality Improvement Organizations (QIN-QIOs) Outpatient Implementation of the Core Elements Just finished recruitment of >7000 facilities Nursing homes required to have stewardship programs The Joint Commission new accreditation standard requires hospitals to have stewardship programs International Cooperation to Improve Antibiotic Use Transatlantic Taskforce on Antimicrobial Resistance (TATFAR) TATFAR was created in 2009 to improve cooperation between the US and the European Union to reduce the threat of antibiotic resistance: 1.1. Develop guidance for assessing appropriate antibiotic use 1.2 Continue the coordination of campaigns to promote appropriate antibiotic use in human medicine International observances to raise awareness of antibiotic resistance and the importance of improving antibiotic use US Antibiotic Awareness Week (November 13 19, 2017) coincides with World Antibiotic Awareness Week and European Antibiotic Awareness Day 12

13 CDC s Communications Efforts to Improve Antibiotic Use CDC launched the National Campaign for Appropriate Antibiotic Use in the Community in 1995 Get Smart Campaign launched in 2003 with a focus on improving antibiotic use for respiratory infections in children and adults in doctors offices Antibiotic Use Educational Effort Develop a high-impact, national communications effort to improve antibiotic use Anticipated outcomes: o raise awareness about the importance of appropriate antibiotic use in preventing antibiotic resistance o support improved prescribing among healthcare providers o support improved antibiotic use among consumers 13

14 Target Audiences Patients Women & mothers ages (African American, Caucasian, and Hispanic) Healthcare Providers Physicians (Emergency Department, Urgent Care, Hospitalists, Family Practitioners) Family care nurse practitioners and physician assistants Secondary, longer-term audiences may include: nursing home staff, dentists, medical students/student physicians, farm workers, and individuals who represent the veterinary medicine and animal agriculture communities And The New Brand Is 14

15 Be Antibiotics Aware Materials New and updated materials include: Fact sheets Posters Brochure Infographics Video, radio, and print public service announcements (PSAs) Shareable GIFs and graphics Animated video Virus vs. Bacteria Chart All materials are posted on new CDC website: 15

16 Be Antibiotics Aware Resources Be Antibiotics Aware Resources ` 16

17 Be Antibiotics Aware Launch & US Antibiotic Awareness Week Activities Blasts to Stakeholders Safe Healthcare Blogs featuring personal stories from partners & patients GovD Communications Social and Digital Media Thunderclap Global Twitter Chat Paid Media Internal CDC Promotion Stakeholder Toolkit 17

18 Progress and Opportunities CDC launching a new educational effort to reach new audiences Modest improvements in antibiotic prescribing observed Opportunities to continue to improve antibiotic prescribing Uptake of stewardship programs and activities increasing rapidly Federal agencies and partners committed to improving antibiotic prescribing CDC working with partners to scale up and sustain stewardship in all healthcare settings antibioticuse@cdc.gov For more information, contact CDC CDC-INFO ( ) TTY: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. 18

19 The Right Tool PSA Questions & Answers 19

20 CME/CNE Credit & Webinar Evaluation The National Foundation for Infectious Diseases (NFID) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians. NFID designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit TM. This continuing nursing education activity was approved by the Ohio Nurses Association, an accredited approver by the American Nurses Credentialing Center s Commission on Accreditation (OBN ). This education activity has been approved for a maximum of 1.o contact hour. To receive credit or contact hours, you must complete the online evaluation and pass the post-test with a score of 80% or higher Online evaluation and post-test will be available following the webinar at: Certificate will be available for print or download following successful completion of online evaluation and post-test until November 14, Join Us For Upcoming NFID Webinar Shingles Vaccines: What You Need to Know Wednesday, December 6, 2017 at 12:00 PM ET Registration: Subscribe to NFID updates: 20