What drives physicians refusing ASP recommendations?
We looked into it.
Just got done presenting our #IDWeek2022 oral abstract.
#IDTwitter
🧵
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We looked into it.
Just got done presenting our #IDWeek2022 oral abstract.
#IDTwitter
🧵
1/
First, there are a bunch of ways to do TeleASP, but especially the more "intense" models have shown success and can be as good as on-site programs.
Our prior work: academic.oup.com/cid/article/71…
SCORE trial from @E_Stenehjem et al.: academic.oup.com/cid/article/67…
#IDWeek2022
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Our prior work: academic.oup.com/cid/article/71…
SCORE trial from @E_Stenehjem et al.: academic.oup.com/cid/article/67…
#IDWeek2022
2/
What do we know already about what influences rec acceptance?
Summary of prior work, including great work from @BRxAD - surgeons tend to be less accepting, and recs that reduce antibiotic exposure refused more.
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Summary of prior work, including great work from @BRxAD - surgeons tend to be less accepting, and recs that reduce antibiotic exposure refused more.
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Structure of the program (ID doc review with non-clinical pharmacist -> recs to primary team).
30 months of data and variables we tracked, including physician characteristics, for which there's less data.
#IDWeek2022
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30 months of data and variables we tracked, including physician characteristics, for which there's less data.
#IDWeek2022
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But what variables mattered?
Whether there was an APP involved and whether we spent one on one time with the physician explaining the program didn't.
#IDWeek2022
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Whether there was an APP involved and whether we spent one on one time with the physician explaining the program didn't.
#IDWeek2022
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On univariable analysis, those surgeons didn't look great. Neither did pulmonologists or private practice PCPs.
But in multivariable, no longer significant.
#IDWeek2022
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But in multivariable, no longer significant.
#IDWeek2022
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So what was significant?
✅ Female > male
✅ Type of rec mattered - stop/discontinue = lower odds of acceptance
And the big one:
21+ years experience = lowest odds of acceptance
(I'll come back to CCM in a minute)
#IDWeek2022
9/
✅ Female > male
✅ Type of rec mattered - stop/discontinue = lower odds of acceptance
And the big one:
21+ years experience = lowest odds of acceptance
(I'll come back to CCM in a minute)
#IDWeek2022
9/
Some thoughts on why the meeting wasn't important - we empowered local pharmacists and they became a trusted local resource.
Actually this is great - if the ID docs don't need to be on site, a given TeleASP can have more impact without geographic limits.
#IDWeek2022
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Actually this is great - if the ID docs don't need to be on site, a given TeleASP can have more impact without geographic limits.
#IDWeek2022
10/
We did find that recs to limit antibiotic use led to lower acceptance. Makes sense.
But specialty wasn't significant in multivariable.
Why?
#IDWeek2022
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But specialty wasn't significant in multivariable.
Why?
#IDWeek2022
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Because years of experience seemed to be more important.
Maybe the surgeons/private practice PCPs/pulmonologists trended toward older and male.
#IDWeek2022
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Maybe the surgeons/private practice PCPs/pulmonologists trended toward older and male.
#IDWeek2022
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Of course have some limitations, one of which is low n of CCM docs, one of whom was super engaged - so wouldn't generalize our CCM findings.
#IDWeek2022
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#IDWeek2022
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Final thoughts - this might help us think about who could use some extra ASP education or targeted intervention.
#IDWeek2022
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#IDWeek2022
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And thanks to my co-authors, our @AHNtoday ASP team, and the HVHS pharmacists.
@TomWalshMD13 @matthewmof31 @canigetazpak @dnbrems @DustinRCarr @cbuchananpharm @CessnaPharmD
#IDWeek2022
15/
@TomWalshMD13 @matthewmof31 @canigetazpak @dnbrems @DustinRCarr @cbuchananpharm @CessnaPharmD
#IDWeek2022
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