title: Impact of Antimicrobial Stewardship on Physician Practice in a Geriatric Facility.
abstract: There is a paucity of literature describing the implementation of antimicrobial stewardship programs (ASPs) in long-term care (LTC) facilities. The current study evaluated the impact of an ASP that was implemented across a geriatric facility, which included an inpatient specialty hospital and an LTC facility. The program included prospective audits with feedback, multidisciplinary education, information technology interventions, and guideline development.
  
  
  
  To investigate the impact of the ASP on physicians' prescribing practices in this geriatric facility.
  
  
  
  Utilization data for antibiotics commonly used to treat urinary tract infections were retrieved for the period September 1, 2011, to August 31, 2013. The study examined whether there were significant changes in overall antibiotic use, ciprofloxacin use, and physician prescribing behaviour after program implementation in September 2012.
  
  
  
  There was no significant change in the total number of antibiotic prescriptions for urinary tract infections in the hospital or the LTC facility after ASP implementation. Significant reductions were seen in the average days of therapy initially prescribed and the actual days of therapy after ASP implementation in the LTC facility but not the hospital. Across both facilities, significant reductions were seen in the number of ciprofloxacin prescriptions.
  
  
  
  The current study showed that an ASP can affect physicians' antibiotic prescribing behaviour and antibiotic usage in an LTC environment.
authors.affiliation: , BScPhm, RPh, is with the Department of Pharmacy, University Health Network, Toronto, Ontario.
authors.forename: Nina
authors.initials: N
authors.lastname: Kassett
authors.affiliation: , MSc, is with the Kunin-Lunenfeld Applied and Evaluative Research Unit, Baycrest Health Sciences, Toronto, Ontario.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Sham
authors.affiliation: , PhD, is with the Kunin-Lunenfeld Applied and Evaluative Research Unit, Baycrest Health Sciences, Toronto, Ontario.
authors.forename: Rosanne
authors.initials: R
authors.lastname: Aleong
authors.affiliation: , BScPhm, PharmD, is with the Department of Pharmacy, Baycrest Health Sciences, Toronto, Ontario.
authors.forename: Daisy
authors.initials: D
authors.lastname: Yang
authors.affiliation: , MD, CCFP, is with the Department of Family Medicine, Baycrest Health Sciences, Toronto, Ontario.
authors.forename: Michael
authors.initials: M
authors.lastname: Kirzner
authors.affiliation: , MDCM, FCFP, is with the Department of Family Medicine, Baycrest Health Sciences, Toronto, Ontario.
authors.forename: Aidlee
authors.initials: A
authors.lastname: Craft
keywords: antibiotics; antimicrobial stewardship; long-term care; practice modification; urinary tract infection