200. Pharmacist Prescribing and Care for Patients with Uncomplicated Urinary Tract Infections in the Community: Antimicrobial Utilization and Stewardship Results of the RxOUTMAP Study
Bibliographic record
Abstract
Urinary tract infections (UTI) are common infections that often result in antibacterial use that is suboptimal. There are some Canadian provinces where pharmacists have the authorization to prescribe medications for the treatment of uncomplicated UTI. Pharmacists are accessible primary care professionals who have an important role to play in antimicrobial stewardship. Our objective was to evaluate the appropriateness of antibacterial prescribing by pharmacists for patients with uncomplicated UTI. We conducted a prospective registry trial in 39 community pharmacies in the Canadian province of New Brunswick. Adult patients were enrolled if they presented to the pharmacy with either symptoms of UTI with no current antibacterial treatment (Pharmacist-Initial Arm) or if they presented with a prescription for an antibacterial to treat UTI from a physician (Physician-Initial Arm). Pharmacists assessed patients and if they had complicating factors or red flags for systemic illness of pyelonephritis, they were excluded from the study. Pharmacists either prescribed antibacterial therapy, modified antibacterial therapy, provided education only, or referred to a physician, as appropriate. Antibacterial therapy prescribed was compared between the study arms. A total of 748 patients were enrolled (87% in the Pharmacist-Initial Arm). The most commonly prescribed agents in the Pharmacist-Initial Arm were nitrofurantoin (88%), sulfamethoxazole–trimethoprim (TMP-SMX) (8%), and fosfomycin (2%) vs. nitrofurantoin (54%), TMP-SMX (26%), and fluoroquinolones (11%) in the Physician-Initial Arm. Nitrofurantoin was prescribed for 5 days in 97% of Pharmacist-Initial orders when compared with Physician-Initial orders where 65% were for greater than 5 days. TMP-SMX was prescribed for 3 days in 88% of Pharmacist-Initial compared with Physician-Initial where 63% were for greater than 3 days. Therapy was guideline concordant in 95% of Pharmacist-Initial compared with 35% of Physician-Initial (P < 0.001). For guideline-discordant therapy from physicians, pharmacists prescribed to optimize therapy for 46% of patients. Treatment was more guideline concordant when initiated by pharmacists, with longer treatment durations and more fluoroquinolones prescribed by physicians. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".