On June 2, 2015, the White House Forum on Antibiotic Stewardship convened leaders in agriculture, and animal and human health, as well as representatives from the pharmaceutical and food safety industries. The event followed the March release of the National Action Plan to Combat Antibiotic-Resistant Bacteria.
One of the speakers, John F. Loome, MD, an internist and Senior Vice President of Medical Affairs for the East Division of Genesis HealthCare, shared how Genesis, the country’s largest provider of long-term care homes and skilled nursing facilities, has committed time and resources to responsible prescribing and disseminates best practices related to reducing unnecessary antibiotic use in the nursing home setting.
“One of the things we teach our providers—in accordance with the ABIM Foundation—is the Choosing Wisely® campaign, which … espouses a lot of these principles about sensible prescribing,” Dr. Loome said during a panel discussion moderated by Tom Frieden, MD, Director of the Centers for Disease Control and Prevention (CDC).
Following the forum, Dr. Loome said Genesis has been aware of the Choosing Wisely campaign since its inception and that many of the recommendations are relevant to their patient population. Through his role with Genesis Physician Services, which comprises more than 200 full- and part-time providers and 200 nurse practitioners, Dr. Loome ensures that new hires are familiar with the Choosing Wisely website and has folded the campaign into ongoing physician education.
One of his major focuses is institutionalizing AMDA’s recommendation against obtaining a urine culture unless there are clear signs and symptoms that localize to the urinary tract. Dr. Loome said in the nursing home setting, urinary tract infections (UTIs) are often overdiagnosed and patients are given unnecessary antibiotics for treatment. His goal is to teach providers to focus on figuring out if they are treating an actual UTI and if they are using the correct dose and for the correct duration.
“There is a great deal of antibiotic utilization – not just at Genesis, but in the entire industry,” Dr. Loome said. “We need to support physicians on how to make an accurate diagnosis based on patient symptomatology in order to direct appropriate testing and prescribing and to have conversations with family members about the risks of providing antibiotics when they aren’t necessary.”
He said overprescribing and irresponsible prescribing can lead to adverse events, including diarrhea and colitis from Clostridium difficile infections as well as increased risk of antibiotic-resistant bacteria. As announced at the White House forum, Genesis was one of more than 150 private sector partners and business leaders making commitments to curb the spread of antibiotic-resistant bacteria.
Later this year, Dr. Loome said Genesis plans to look at pharmacy data for prescriptions that are used for UTIs, including Cipro and Bactrim, and examine data pulled from cultures to see if they are indicating UTIs or not.
He said the main challenge physicians face around antibiotic prescribing is pressure from family members just because there is something wrong with the patient.
“Our focus should be on doing the right thing and taking the time to figure out what is exactly going on so it can be treated appropriately,” Dr. Loome said. “We tell providers to refer people and families to the Choosing Wisely website so they can better understand these complex decisions.”