Abstract：
Background: The most modifiable risk factor contributing to antibiotic resistance is the inappropriate prescription of antibiotics. Urinary tract infections (UTIs) are a common outpatient infection in the United States, with increasing antimicrobial resistance to uropathogens. As empiric UTI treatment is often appropriate, telemedicine offers an opportunity to enhance practice by adopting current clinical practice guidelines. Objective: The project aims to improve appropriate first-line antibiotic choice and decrease urinalysis and urine culture orders in the telehealth management of uncomplicated UTIs. Methods: Chart reviews of women aged 18-65 years diagnosed with an uncomplicated UTI and/or symptoms during a telehealth primary care visit were conducted for a period of 30 days prior to and following a provider educational intervention. Results: Improvement (37.5%-62.1%, p = .133), though not significant, of appropriate first-line antibiotics prescribing postintervention was achieved. There was a minimal (3%) improvement in the appropriate urine labs ordered. Conclusion: Following the intervention, there was not a statistically significant practice change, albeit somewhat of an improvement in the ordering of first-line antibiotics. Adopting evidence-based practice in telehealth could provide an opportunity to improve antibiotic stewardship. Providers are potentially better engaged through the presence of champions, in-person education sessions, and the availability of streamlined algorithms.
摘要：
背景：导致抗生素耐药性的最可改变的危险因素是不适当的抗生素处方。尿路感染（UTI）是美国常见的门诊感染，随着对尿路病原体的耐药性增加。由于经验性UTI治疗通常是合适的，通过采用当前的临床实践指南，远程医疗提供了一个加强实践的机会。目的:在非复杂性尿路感染的远程健康管理中,改进适当的一线抗生素选择,减少尿分析和尿培养顺序。方法：在提供者进行教育干预之前和之后的30天，对在远程保健初级保健访问中被诊断为无并发症UTI和/或症状的18-65岁女性进行了图表审查。结果：改善（37.5％-62.1％，p=.133)，虽然不重要，干预后获得了适当的一线抗生素处方。在订购的适当尿液实验室中，有最小（3％）的改善。结论:干预后,没有统计上显著的实践变化，尽管一线抗生素的订购有所改善。在远程医疗中采用循证实践可以为改善抗生素管理提供机会。通过冠军的存在，提供商可能会更好地参与其中，面对面的教育会议，以及简化算法的可用性。
