Implementation of a novel antimicrobial stewardship strategy for rural facilities utilising telehealth.

A significant portion of healthcare takes place in small hospitals, and many are located in rural and regional areas. Facilities in these regions frequently do not have adequate resources to implement an on-site Antimicrobial Stewardship Program (ASP) and there is limited data relating to their implementation and effectiveness. We present an innovative model of providing specialist telehealth antimicrobial stewardship service, utilising a centralised service namely the Queensland Statewide Antimicrobial Stewardship Program, to a rural Hospital and Health Service (HHS). Results of a two-year post-implementation follow-up, showed an improvement to both the adherence to guidelines [33.7%, 95% CI:27.0-40.4 vs (54.1%, 95% CI:48.7-59.5] and appropriateness of antimicrobial prescribing [49%, 95% CI:42.2-55.9] vs [67.5%, 95% CI:62.7-72.4] (p < 0.001). This finding was sustained after adjustment for hospitals, with improvement occurring sequentially across the years for adherence to guidelines and appropriateness of prescribing [Adjusted Odds Ratio [AOR 2.44, 95% CI: 1.70-3.51] and [AOR 2.48, 95% CI: 1.70-3.61], respectively. There was a decrease in means of total antibiotic use (DDDs/1000 patient days) between the time period of 2016 [52.82, 95% CI: 44.09-61.54] to 2018 [39.74, 95% CI: 32.76-46.73], however this did not reach statistical significance. In addition, there was a decrease in mean hospital length of stay from 2016[3.74, 95% CI:3.08-4.41] as compared to 2018 [2.55, 95% CI:1.98-3.12], though this did not reach statistical significance. In summary, new telehealth-based models of antimicrobial stewardship can be effective in improving prescribing in rural areas. Programs similar to ours should be considered for rural facilities.