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Abstract：
To provide an overview of the impact of pharmacist interventions on antibiotic prescribing and the resultant clinical outcomes in an outpatient antibiotic stewardship program (ASP) in the United States.
Reports on studies of pharmacist-led ASP interventions implemented in US outpatient settings published from January 2000 to November 2020 and indexed in PubMed or Google Scholar were included. Additionally, studies documented at the ClinicalTrials.gov website were evaluated. Study selection was based on predetermined inclusion criteria; only randomized controlled trials, observational studies, nonrandomized controlled trials, and case-control studies conducted in outpatient settings in the United States were included. The primary outcome was the observed differences in antibiotic prescribing or clinical benefits between pharmacist-led ASP interventions and usual care.
Of the 196 studies retrieved for full-text review, a cumulative total of 15 studies were included for final evaluation. Upon analysis, we observed that there was no consistent methodology in the implementation of ASPs and, in most cases, the outcome of interest varied. Nonetheless, there was a trend toward improvement in antibiotic prescribing with pharmacist interventions in ASPs compared with that under usual care (P < 0.05). However, the results of these studies are not easily generalizable.
Our findings suggest a need for a consistent approach for the practical application of outpatient pharmacist-led ASPs. Managed care organizations could play a significant role in ensuring the successful implementation of pharmacist-led ASPs in outpatient settings.
Reports on studies of pharmacist-led ASP interventions implemented in US outpatient settings published from January 2000 to November 2020 and indexed in PubMed or Google Scholar were included. Additionally, studies documented at the ClinicalTrials.gov website were evaluated. Study selection was based on predetermined inclusion criteria; only randomized controlled trials, observational studies, nonrandomized controlled trials, and case-control studies conducted in outpatient settings in the United States were included. The primary outcome was the observed differences in antibiotic prescribing or clinical benefits between pharmacist-led ASP interventions and usual care.
Of the 196 studies retrieved for full-text review, a cumulative total of 15 studies were included for final evaluation. Upon analysis, we observed that there was no consistent methodology in the implementation of ASPs and, in most cases, the outcome of interest varied. Nonetheless, there was a trend toward improvement in antibiotic prescribing with pharmacist interventions in ASPs compared with that under usual care (P < 0.05). However, the results of these studies are not easily generalizable.
Our findings suggest a need for a consistent approach for the practical application of outpatient pharmacist-led ASPs. Managed care organizations could play a significant role in ensuring the successful implementation of pharmacist-led ASPs in outpatient settings.
摘要：
概述美国门诊抗生素管理计划（ASP）中药剂师干预对抗生素处方的影响以及由此产生的临床结果。
纳入了2000年1月至2020年11月在美国门诊环境中实施的药剂师主导的ASP干预措施研究报告，并在PubMed或GoogleScholar中进行了索引。此外,对ClinicalTrials.gov网站上记录的研究进行了评估。研究选择基于预定的纳入标准；只有随机对照试验，观察性研究，非随机对照试验，纳入了在美国门诊进行的病例对照研究.主要结果是观察到的抗生素处方或药剂师主导的ASP干预和常规护理之间的临床益处的差异。
在全文回顾的196项研究中，累计纳入15项研究进行最终评估.经分析,我们观察到，在实施ASP方面没有一致的方法，在大多数情况下,兴趣的结果各不相同。尽管如此，与常规治疗相比,在ASPs中使用药剂师干预的抗生素处方有改善趋势(P<0.05).然而,这些研究的结果不容易推广。
我们的研究结果表明，需要一种一致的方法来实际应用门诊药剂师主导的ASP。管理式护理组织可以在确保在门诊环境中成功实施药剂师主导的ASP方面发挥重要作用。
纳入了2000年1月至2020年11月在美国门诊环境中实施的药剂师主导的ASP干预措施研究报告，并在PubMed或GoogleScholar中进行了索引。此外,对ClinicalTrials.gov网站上记录的研究进行了评估。研究选择基于预定的纳入标准；只有随机对照试验，观察性研究，非随机对照试验，纳入了在美国门诊进行的病例对照研究.主要结果是观察到的抗生素处方或药剂师主导的ASP干预和常规护理之间的临床益处的差异。
在全文回顾的196项研究中，累计纳入15项研究进行最终评估.经分析,我们观察到，在实施ASP方面没有一致的方法，在大多数情况下,兴趣的结果各不相同。尽管如此，与常规治疗相比,在ASPs中使用药剂师干预的抗生素处方有改善趋势(P<0.05).然而,这些研究的结果不容易推广。
我们的研究结果表明，需要一种一致的方法来实际应用门诊药剂师主导的ASP。管理式护理组织可以在确保在门诊环境中成功实施药剂师主导的ASP方面发挥重要作用。
