Bagging Antibiotics in Maine
Elizabeth Dennis, DO, said it’s challenging to see a patient who is not feeling well and discuss why antibiotics won’t help them. So she found a way to avoid sending patients with a respiratory illness home empty-handed.
Dr. Dennis, Chair of Infection Control and Outpatient Medical Director for Mayo Regional Hospital in Maine, created Wellness Bags for clinicians to give patients to alleviate a persistent cough or runny nose – instead of antibiotics. The bags included tissues, cough drops, hand sanitizer and Choosing Wisely materials from Consumer Reports about why antibiotics are not recommended for treating bronchitis and other respiratory illnesses.
The intervention started when Dr. Dennis was doing routine chart reviews and recognized that many patients with bronchitis were being sent home with antibiotics. This stood out to her as contrary to Choosing Wisely antibiotic stewardship efforts she had learned about through Choosing Wisely grantee Maine Quality Counts.
When she brought up the topic with colleagues, she heard frustration about patients who were not prescribed antibiotics during the office visit going to the emergency room to get a prescription. An in-depth chart review on the frequency with which antibiotics were prescribed to patients diagnosed with bronchitis in the ER and five Mayo primary care practices confirmed that the organization wasn’t adhering to evidence-based guidelines.
Armed with this baseline data and Choosing Wisely resources, Dr. Dennis discussed the Wellness Bags with the senior team and got approval. For a few hundred dollars, all the providers received about 20 bags to use at their discretion in January 2017. The Consumer Reports materials were free, including the patient handouts and posters that Mayo clinicians hung in their offices and waiting rooms.
Dr. Dennis sent an email out to alert everyone about the initiative and spoke about it during bi-monthly meetings to make sure that the messages were consistent across the organization. If a patient came in with a respiratory illness that did not require treatment with an antibiotic, clinicians would give them a bag and discuss how they could try to keep them safe and comfortable without antibiotics.
Comparing chart data from January–March 2016 to the same period in 2017, Dr. Dennis found that antibiotic prescriptions fell from 84 percent in primary care practices before the intervention to 8 percent after the intervention. Antibiotic prescriptions fell from 67 percent to 54 percent in the ER during the same period.
“I asked the team why the bags were a success and many told me they felt empowered,” she said. “They had something to generate a conversation with patients and it was a collaborative initiative across the organization. We are hopeful to continue to distribute bags again in January 2018 and are exploring partnerships with local companies to help supply the contents.”
