What changes were seen after feedback?
STIS, SEXUALLY TRANSMITTED INFECTIONS, SEXUALLY TRANSMITTED INFECTION, UTI
Both the control group and the feedback group demonstrated improvement from the baseline to the third audit (TableThus, the remainder of the discussion will focus on the change over time in both groups.Since the baseline data had suggested the importance of workup for possible STIs, it was emphasized in the CME and improvement was expected. Unfortunately, this did not improve after the CME or feedback. After the CME, 27% had documented; yet only 1% had a vaginal examination performed, 1% had a urine culture done, and 1% had workup for a sexually transmitted infection. Thus, it is likely that many sexually transmitted infections are missed in the outpatient setting.The use of diagnostic tests that are not indicated have the potential of increasing inappropriate antimicrobial use and are the focus of diagnostic stewardship interventions. One of the most common of those tests is the CBC which is commonly used in the local setting as the determinant for starting antibiotics even in the absence of indications for antimicrobial therapy (unpublished observations). Thus, it is of particular concern that the use of the CBC actually went up over time and was ordered in over 80% of the patients from the final audit. Also notable, was One of the other goals of the CME and feedback was to increase the use of nitrofurantoin for UTI. but the use went up only from 2 to 8%. However, there was a notable decrease in the use of the quinolones and a compensatory increase in cephalosporin use. This can be considered a favorable although not optimal change in view of the risks for 