Leveraging an Antimicrobial Stewardship Collaborative and Urgent Care Center Medication-dispensing Kiosks to Support Shorter Antibiotic Durations: a Multisite, Retrospective Evaluation.

BACKGROUND: Outpatient medication dispensing kiosks that contain antibiotics are proliferating. This study aimed to evaluate how their implementation in urgent care centers (UCCs) alongside antimicrobial stewardship program (ASP) collaborative engagement can influence antibiotic prescribing. METHODS: This retrospective cohort study included 20 UCCs, evaluating antibiotic electronic prescriptions (eRx) ordered in January-June 2019 (preintervention period) versus January-June 2024 (postintervention period). In late 2019, kiosks containing antibiotics were placed in UCCs, with initial kiosk inventories based on historical eRx volumes. Serendipitously, an outpatient ASP collaborative was established around the same time. Between the preintervention/postintervention periods, numerous programmatic interventions were implemented to promote rational antibiotic prescribing, including kiosk inventory modifications, education, and stakeholder engagement. Data on eRx prescribing for 12 antibiotics were obtained. The primary outcome was antibiotic days of therapy (DOT) per eRx. Secondary outcomes included antibiotic-specific changes, kiosk utilization, and an estimate of the intervention's impact. RESULTS: In the preintervention period, 38 593 eRx were included with 325 400 DOT, as compared to 45 608 eRx with 355 502 DOT in the postintervention period (8.4 vs 7.8 DOT/eRx, respectively; P < .001). In the preintervention period 8649 eRx (22%) were routed to a kiosk, compared with 25 414 eRx (56%) in the postintervention period (P < .001). An estimated 33 340 DOT were avoided in the postintervention period. CONCLUSIONS: Engagement of an antimicrobial stewardship collaborative along with implementation of UCC kiosks containing antibiotics may support prescriber practices that align with stewardship principles and safer outpatient antibiotic use. For healthcare systems considering kiosk adoption, early and sustained ASP involvement in inventory decisions appears critical, which the contents of this article may serve to support as a template.