Lance's Corner

AHRQ Highlights Efforts to Reduce Unsafe Use of Antibiotics

Nov 22, 2024

Per the notice below, the Agency for Healthcare Research and Quality (AHRQ) is highlighting its efforts to reduce the unsafe use of antibiotics.

Investigating Interventions to Reduce Unsafe Use of Antibiotics

“It is wonderful that the Agency for Healthcare Research and Quality offers funding focusing on patient safety, particularly for underserved populations.  With AHRQ’s help, my goal is to improve antibiotic use and minimize antimicrobial resistance.”

Antibiotic stewardship is vitally important to both individual and public health because inappropriate antibiotic use can lead to antibiotic-resistant bacteria, which can make antibiotics ineffective.  Larissa Grigoryan, M.D., Ph.D., is focusing her AHRQ-funded research on reducing the inappropriate use of antibiotics, specifically in outpatient care.  Dr. Grigoryan, an associate professor of family and community medicine at Baylor College of Medicine, is developing and testing antibiotic stewardship interventions, making healthcare safer.  Unsafe antibiotic use includes using antibiotics without a prescription, which could mean using another person’s medication or using your own leftover antibiotics.  Using antibiotics inappropriately—for instance, not finishing all doses prescribed—leads to increased antibiotic resistance and adverse drug reactions.

In 2019, Dr. Grigoryan began serving as a co-principal investigator on a 5-year AHRQ grant to explore why nonprescription antibiotic use occurs.  The study focused on low-income patients seen at safety-net primary care clinics, where uninsured and other vulnerable patients receive healthcare.  Dr. Grigoryan collaborated with AHRQ grantee Barbara Trautner, M.D., Ph.D., in conducting this study.  They found a lack of health insurance, high cost of doctor visits, and lack of transportation for medical appointments were primary reasons people used antibiotics without a prescription.

Building on her antibiotic stewardship research, Dr. Grigoryan served as a co-principal investigator on a 2-year AHRQ grant in 2020 to study the prevalence and predictors of antibiotic use without a prescription in children.  The study found that educating people on the appropriate use of antibiotics shows promise to decrease nonprescription antibiotic use.  During testing of the educational materials, the research team found that people liked information on alternative ways to treat different symptoms and conditions.  Many had been unaware of any negative effects, such as antibiotic resistance and adverse drug reactions, from the unsafe use of antibiotics.  They also found participants appreciated information on alterative remedies that reduce the need for antibiotics.  Results of the study are guiding development of an educational intervention.

Currently, Dr. Grigoryan is tackling the overprescribing of antibiotics from a different angle: the misdiagnoses of urinary tract infections (UTIs).  She is the lead investigator on a 5-year AHRQ grant awarded in 2023.  The aim of this project is to create a program that will educate patients on the correct method for collecting urine to be used for a culture—a test healthcare providers use to check for UTIs.  This project focuses on low-income patients without health insurance.  The team has designed and is testing a short, animated educational video and flyer.  Both the video and flyer are being created in English and Spanish.  If the project succeeds in reducing contaminated urine cultures, this will help reduce unnecessary antibiotic use, slow the emergence of antimicrobial resistance, and preserve the effectiveness of antibiotics for current and future generations.  It will also reduce waste of laboratory resources, decreasing costs for both patients and healthcare institutions.  This project will end May 31, 2028.

“I’m so grateful to AHRQ for the ability to do this kind of work,” said Dr. Grigoryan, who is also an investigator for the Center for Innovations in Quality, Effectiveness and Safety at the Michael E. DeBakey VA Medical Center in Houston.  “Without AHRQ’s support, we wouldn’t have an opportunity to carry out these projects.”

Related AHRQ Resources

Toolkit To Improve Antibiotic Use in Ambulatory Care

USDOL Issues Comprehensive Employer Guidance on Long COVID

The United States Department of Labor (USDOL) has issued a comprehensive set of resources that can be accessed below for employers on dealing with Long COVID.

Supporting Employees with Long COVID: A Guide for Employers

The “Supporting Employees with Long COVID” guide from the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) and Job Accommodation Network (JAN) addresses the basics of Long COVID, including its intersection with mental health, and common workplace supports for different symptoms.  It also explores employers’ responsibilities to provide reasonable accommodations and answers frequently asked questions about Long COVID and employment, including inquiries related to telework and leave.

Download the guide

Accommodation and Compliance: Long COVID

The Long COVID Accommodation and Compliance webpage from the USDOL-funded Job Accommodation Network (JAN) helps employers and employees understand strategies for supporting workers with Long COVID.  Topics include Long COVID in the context of disability under the Americans with Disabilities Act (ADA), specific accommodation ideas based on limitations or work-related functions, common situations and solutions, and questions to consider when identifying effective accommodations for employees with Long COVID.  Find this and other Long COVID resources from JAN, below:

Long COVID, Disability and Underserved Communities: Recommendations for Employers

The research-to-practice brief “Long COVID, Disability and Underserved Communities” synthesizes an extensive review of documents, literature and data sources, conducted by the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) on the impact of Long COVID on employment, with a focus on demographic differences.  It also outlines recommended actions organizations can take to create a supportive and inclusive workplace culture for people with Long COVID, especially those with disabilities who belong to other historically underserved groups.

Read the brief

Long COVID and Disability Accommodations in the Workplace

The policy brief “Long COVID and Disability Accommodations in the Workplace” explores Long COVID’s impact on the workforce and provides examples of policy actions different states are taking to help affected people remain at work or return when ready.  It was developed by the National Conference of State Legislatures (NCSL) as part of its involvement in USDOL’s State Exchange on Employment and Disability (SEED) initiative.

Download the policy brief

Understanding and Addressing the Workplace Challenges Related to Long COVID

The report “Understanding and Addressing the Workplace Challenges Related to Long COVID” summarizes key themes and takeaways from an ePolicyWorks national online dialogue through which members of the public were invited to share their experiences and insights regarding workplace challenges posed by Long COVID.  The dialogue took place during summer 2022 and was hosted by USDOL and its agencies in collaboration with the Centers for Disease Control and Prevention and the U.S. Surgeon General.

Download the report

Working with Long COVID

The USDOL-published “Working with Long COVID” fact sheet shares strategies for supporting workers with Long COVID, including accommodations for common symptoms and resources for further guidance and assistance with specific situations.

Download the fact sheet

COVID-19: Long-Term Symptoms

This USDOL motion graphic informs workers with Long COVID that they may be entitled to temporary or long-term supports to help them stay on the job or return to work when ready, and shares where they can find related assistance.

Watch the motion graphic

A Personal Story of Long COVID and Disability Disclosure

In the podcast “A Personal Story of Long COVID and Disability Disclosure,” Pam Bingham, senior program manager for Intuit’s Diversity, Equity and Inclusion in Tech team, shares her personal experience of navigating Long COVID symptoms at work.  The segment was produced by the USDOL-funded Partnership on Employment and Accessible Technology (PEAT) as part of its ongoing “Future of Work” podcast series.

Listen to the podcast

HHS OIG Issues Annual Report on State MFCUs

Per the notice below, the Office of the Inspector General (OIG) of the United States Department of Health and Human Services (HHS) has issued its annual report on the performance of state Medicaid Fraud Control Units (MFCUs).

Medicaid Fraud Control Units Fiscal Year 2023 Annual Report (OEI-09-24-00200) 

Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. OIG is the Federal agency that oversees and annually approves federal funding for MFCUs through a recertification process. This new report analyzed the statistical data on annual case outcomes—such as convictions, civil settlements and judgments, and recoveries—that the 53 MFCUs submitted for Fiscal Year 2023.  New York data is as follows:

Outcomes

  • Investigations1 - 556
  • Indicted/Charged - 9
  • Convictions - 8
  • Civil Settlements/Judgments - 28
  • Recoveries2 - $73,204,518

Resources

  • MFCU Expenditures3 - $55,964,293
  • Staff on Board4 - 257

1Investigations are defined as the total number of open investigations at the end of the fiscal year.

2Recoveries are defined as the amount of money that defendants are required to pay as a result of a settlement, judgment, or prefiling settlement in criminal and civil cases and may not reflect actual collections.  Recoveries may involve cases that include participation by other Federal and State agencies.

3MFCU and Medicaid Expenditures include both State and Federal expenditures.

4Staff on Board is defined as the total number of staff employed by the Unit at the end of the fiscal year.

Read the Full Report

View the Statistical Chart

Engage with the Interactive Map

GAO Issues Report on Medicaid Managed Care Service Denials and Appeal Outcomes

The United States Government Accountability Office (GAO) has issued a report on federal use of state data on Medicaid managed care service denials and appeal outcomes.  GAO found that federal oversight is limited because it doesn't require states to report on Medicaid managed care service denials or appeal outcomes and there has not been much progress on plans to analyze and make the data publicly available.  To read the GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the first link below.  To read GAO highlights of the report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the second link below.
https://www.gao.gov/assets/d24106627.pdf  (GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes)
https://www.gao.gov/assets/d24106627_high.pdf  (GAO highlights on federal use of state data on Medicaid managed care service denials and appeal outcomes)

CMS Issues Latest Medicare Regulatory Activities Update

The Centers for Medicare and Medicaid Services (CMS) has issued its latest update on its regulatory activities in the Medicare program.  While dentistry is only minimally connected to the Medicare program, Medicare drives the majority of health care policies and insurance reimbursement policies throughout the country.  Therefore, it always pays to keep a close eye on what CMS is doing in Medicare.  To read the latest CMS update on its regulatory activities in Medicare, use the link below.
https://www.cms.gov/training-education/medicare-learning-network/newsletter/2024-03-14-mlnc