FINAL OUTCOMES REPORT Clinical Commentary: Multidrug Resistant Bacteria – An Ongoing Global Healthcare Challenge Merck Grant ID: AAN151207035508 Executive Summary (Level 1-2) Reach • 5,874 Participants and 4,991 Certificates • Pharmacist Participants - 4,469 • Pharmacist Completers with Certificate - 3,809 • MDs, PAs, RNs, & NPs Participants - 1,405 • MDs, PAs, RNs, & NPs Completers with Certificate - 1,182 • 62% of participants were pharmacists Satisfaction • 93% of clinicians would recommend this activity to a colleague • 98% of learners did not perceive any bias • 91% of learners rated educational content as good/excellent Learning Objectives • 98% of participants strongly agree/agree that they are better able to meet the learning objectives after completing the activity Impact • 93% of learners stated that the activity increased or validated their competence in practice • 68% of learners will change their practice based on this activity; 35% plan to change the management and/or treatment of my patients • 47% of learners will seek to address potential barriers to patient access to therapies Icon made by FreePik from www.flaticon.com Executive Summary (Level 3-4) Knowledge • Participants demonstrated increased awareness of differences in the definitions of multi-drug resistance • Participants demonstrated increased knowledge of the mechanism of vancomycin-resistant enterococci Competence • Participants demonstrated improved competence in the selection of therapy for a theoretical case patient • Learners reported increased confidence across several areas, including application of local antibiograms and selection of therapy Performance and Patient Outcomes • Clinician learners reported an intent to obtain a culture and refer to their local antibiogram; however, only one-third reported this intent to change • Of pharmacist learners, 51% plan to collaborate with colleagues to discuss best practices and approaches to dosing and duration of therapy • These members of the multidisciplinary team plan to implement changes that may optimize antimicrobial therapy and reduce the development of resistance Icon made by FreePik from www.flaticon.com Future Educational Opportunities Clinician learners are most interested in education on infection control while pharmacist learners are most interested Future Educational in antibiotic stewardship Opportunities Learners would like more knowledge on the clinical application of new antimicrobials Consider case-based activities as learners demonstrated increased competence with newer therapies based on the faculty discussion on selection of therapy for diverse patients Icon made by FreePik from www.flaticon.com Program Overview Overview: This online clinical commentary reviewed the impact of extended-spectrum beta-lactamase (ESBL) and carbapenemase-producing bacteria and presented comparative data on current and emerging therapies to develop strategies for initial therapy and optimal outcomes. Intended Audience: This activity intended to educate physicians, nurses, pharmacists, and other clinicians involved in the treatment of multidrug resistant infections. Activity Date: June 30, 2016 Expiration Date: June 30, 2017 Power-Pak C.E. ™ (Pharmacists) - http://www.powerpak.com/course/preamble/113153 freeCME (MDs, PAs, RNs, & NPs) - https://learning.freecme.com/a/21674PAgzkgE Credit: 1.0 AMA PRA Category 1 Credit™ (Physicians), 1.0 CPE contact hour (Pharmacists) and 0.1 IACET contact hour (Nurses) Sponsored By: The Academy for Continued Healthcare Learning (ACHL) Funding: Supported by an educational grant from Merck Faculty James Lewis, PharmD Clinical Pharmacist Antimicrobial Management Team Department of Pharmacy Services Oregon Health & Science University Portland, OR Carlene A. Muto, MD, MS Associate Professor Department of Medicine, Infectious Diseases University of Virginia Charlottesville, VA Participation Participants: 5874 Clinician Type Certificates: 4991 Physician 7% 8% 10% 7% Physician 4% Assistant 2% Nurse Nurse Practitioner Pharmacist 62% Pharmacist Tech Participation (Cont.) Pharmacy Specialty 1% 14% Academia/Pharmacy School Health Systems Long Term Care/Nursing Home 44% Managed Care Company Pharmacuetical Manufacturer Pharmacy Benefit Manager 31% Psychiatric Hospital Retail Other 1% 1% 2% 2% 4% *other includes ambulatory care, changing setting, compounding, cardio practice, development inst., info tech pharmacist, med education, mail order, drug wholesale distributor Participation (Cont.) Clinician Breakdown 4% 3% 3% Family Practice 4% 12% Uknown Other 7% 9% Internal Medicine 8% Emergency Medicine Pediatrics General Practice 50% Surgery Primary Care *Other includes cardiologists, podiatrists, dermatologists, psychiatrists, gastroenterologists, radiologists, hospitalists etc. Learning Objectives Please rate the following objectives to indicate if you Analysis of are better able to: Respondents Rating Scale: 4=Strongly Agree 1=Strongly Disagree Demonstrate an understanding of the molecular epidemiology of 3.41 antibiotic resistance in bacterial pathogens Summarize the salient features and critical differences amongst 3.40 available antibiotics and those in development for use against multidrug resistant gram-negative bacteria Describe strategies to optimize initial antimicrobial therapy to ensure 3.42 effectiveness of antibiotics and reduce the development of resistance Discuss the interventions with the potential to reduce inappropriate 3.42 use of antibiotics and improve outcomes in patients with resistant bacterial infections Learners Strongly Agree/Agree that all learning objectives were met, with an average rating of N=4,974 3.41/4.0 Faculty Faculty Evaluation Analysis of Respondents 5 = Excellent, 1 = Poor James Lewis, PharmD Carlene A. Muto, MD, MS Ability to effectively convey 4.32 4.34 the subject matter Ability to deliver an objective 4.34 4.35 and balanced presentation Ability to present scientifically 4.33 4.34 rigorous information Expertise on the subject matter 4.37 4.38 The faculty were highly rated across all areas, with an average rating of 4.35/5.0. N=4,974 Satisfaction Overall Evaluation Analysis of Respondents 5=Excellent, 1=Poor Quality of educational content 4.30 Usefulness of educational material 4.29 Effectiveness of teaching method used 4.23 Appropriateness and effectiveness of active learning 4.27 strategies (questions, cases, discussion, etc) Usefulness of educational material and active learning strategies were able to support learning with 4.29 and 4.27 out of 5.0 rating respectively. Quality of educational content was highly rated at 4.30 out of 5.0 N=4,974 Objectivity & Bias Perception of Bias Objectivity & Balance 98% 100% 100% 80% 80% 60% 60% 49% 40% 40% 40% 20% 20% 10% 2% 1% 0% 0% Yes No N=4,989 N=4,956 Activity was viewed as objective, balanced, and non-biased. Levels 3-4: Pretest vs. Posttest Summary Below is a summary of participant responses, based on questions answered at pre-activity and immediately following the activity. 96% 91% 100% 86% 86%85% 86% 81% 72% 47% 48% 50% 31% 31% 38% 23% 22% 28% 0% Q1 Q2 Q3 Q4 Pharmacists Pre n=7,638 Pharmacists Post n=3,809 MDs, PAs, RNs, & NPs Pre n=1,356 MDs, PAs, RNs, & NPs Post n=1,206 Question Topic % Change % Change MD, Pharmacist PA, RN, NP Defining multi-drug resistant Q1 bacteria 274% 227% Q2 Mechanisms of resistance 210% 177% Q3 Selection of therapy 124% 207% Q4 Novel therapies 94% 69% Levels 3-4: Pretest vs. Posttest 1. Definitions of multi-drug resistant bacteria: A. Have been standardized by United States and European organizations B. Vary across hospitals MDs, PAs, RNs, & NPs Pre n=1,356 C. Apply to pathogens that are resistant to one 100% Post n=1,206 or more classes of antimicrobials 72% 58% D. Are consistent across pathogens 75% 50% 22% 16% 25% 10% 11% 4% 0% ABCD Pharmacists Pre n=7,638 Post n=3,809 100% 86% Correct responses increased in both groups of 75% 62% learners after participation in the activity, but 50% pharmacists displayed greater improvement. 23% The baseline results from this question are 12% 25% 9% indicative of the inconsistencies in defining 4% 3% 1% 0% multi-drug resistance across institutions. ABCD Increased awareness of the challenges discussed by the faculty may prompt learners to examine how their respective institution defines multi-drug resistance. Levels 3-4: Pretest vs. Posttest 2. What is the mechanism of resistance of vancomycin-resistant enterococci? A. Change in binding site B. Upregulated efflux pumps C. Enzymatic degradation MDs, PAs, RNs, & NPs Pre n=1,356 D. Outer membrane porin changes Post n=1,206 100% 86% 75% 50% 31% 24% 32% 25% 13% 5% 5% 4% 0% ABCD Pharmacists Pre n=7,638 Both groups of learners had low performance Post n=3,809 on this question around mechanisms of 100% 86% resistance on the pre-test. However, by the 75% end of the activity, knowledge across both 50% 31% groups of learners increased with 29% 20% 20% 25% participants providing correct responses 80% 1% 1% 1% (or greater) of the time. 0% ABCD Levels 3-4: Pretest vs. Posttest 3. A 67-year old woman with a history of smoking is admitted from the ED for rapidly progressing pneumonia. Despite therapy, she exhibits worsening signs and is transferred to the ICU. P. aeruginosa is isolated from sputum specimens. What therapy would you select for her? MDs, PAs, RNs, & NPs Pre n=1,356 A. A carbapenem Post n=1,206 100% B. Ceftolozane-tazobactam 86% C. Piperacillin-tazobactam 75% D. A quinolone 50% 39% 28% 25% 16% 17% 4% 6% 4% 0% ABCD Both groups of learners demonstrated increased Pharmacists Pre n=7,638