Efforts to promote optimal antibiotic use should employ both the public health and healthcare systems. The Public Health Foundation (PHF) is leading an effort to develop and pilot a driver diagram for public health and healthcare to work together to reduce antibiotic resistant infections.
PHF’s Antibiotic Stewardship Program grew out of PHF’s partnership with the Centers for Disease Control and Prevention (CDC)
and the Institute for Healthcare Improvement (IHI)
to develop a framework of key drivers for reducing inappropriate antibiotic utilization in hospitals. The IHI Driver Diagram
focused on hospital-based drivers (e.g., consider local antibiotic susceptibility patterns in selecting therapy, monitor for toxicity and adjust dose promptly); it focused on decreasing adverse drug events, pathogen prevalence, infection incidence, and pharmacy costs within acute care environments. PHF recognized that hospital-based efforts will be most effective when paired with community-based change efforts to address drivers of optimal antibiotic use beyond hospital walls.
The Public Health Antibiotic Stewardship Driver Diagram
In 2012, PHF led development of a driver diagram illustrating public health’s role in promoting antibiotic stewardship. An interdisciplinary team of experts in quality improvement (QI), infection control, epidemiology, and public health leadership, identified primary and secondary drivers of optimal antibiotic use to reduce the spread of antibiotic resistant infections and other adverse impacts of inappropriate antibiotic use. The resulting Public Health Antibiotic Stewardship Driver Diagram
maps drivers of optimal antibiotic use—as a companion to the IHI diagram described above. While some drivers of optimal antibiotic use fall outside the direct control of public health (e.g., use of antibiotics in livestock food supplies), others sit squarely within the focus of the public health system.
When used together, the Public Health Antibiotic Stewardship Driver Diagram and the IHI Antibiotic Stewardship Driver Diagram provide a comprehensive framework for promoting optimal antibiotic use.
Public Health Pilot Initiative
PHF is facilitating pilot activities that use the Public Health Antibiotic Stewardship Driver Diagram in collaborative efforts between the public health and healthcare systems. The pilots' accomplishments included, more adoption of best practices, expanded partnerships and the commitment to continue them, as well as education on appropriate antibiotic use for physicians, pharmacists, and nurses. Current pilot sites are:
At the 2013 meeting of the Antibiotic Stewardship Advisory Group, the three public health pilot sites shared the progress of their work and strategies for effectively collaborating with healthcare partners. Their stories point to several factors that have been critical to the success of these efforts:
- Use of the Public Health Antibiotic Stewardship Driver Diagram. A driver diagram illustrates primary and secondary drivers of a health challenge; each pilot site used the driver diagram as a reference for selecting points of intervention.
- Use of QI Tools and Methods. The work of all three pilots incorporated QI to ensure that improvement strategies were effectively targeted and adopted.
- Collaboration Between Public Health and Healthcare. Each health department functioned as a resource to its healthcare partners, helping them to meet regulatory requirements and address fiscal needs, convening and facilitating productive discussions, and communicating about joint activities.
PHF intends to expand the reach of this program by launching additional pilot work around the country, and is developing an intervention guide to accompany the Public Health Antibiotic Stewardship Driver Diagram.
Antibiotic resistant infections are a growing problem nationwide. The following resources can be of assistance to public health and healthcare organizations: