Antibiotic Use Reports for Infections

(VAST Trial)

Not currently recruiting at 1 trial location

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to improve antibiotic use in VA medical centers, particularly in rural areas lacking local infectious disease experts. The trial will test a Videoconference Antimicrobial Stewardship Team (VAST) to assist doctors in making better antibiotic choices. Some sites will also receive quarterly reports on their antibiotic use. The goal is to reduce unnecessary antibiotic use and combat antibiotic resistance. The trial seeks VA medical centers without local infectious disease experts, pairing them with experts from other centers. As an unphased trial, this study provides a unique opportunity to contribute to innovative healthcare solutions in rural areas.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this protocol is safe for use in VA Medical Centers?

Research has shown that using telehealth to improve antibiotic use is generally safe for participants. In earlier studies, participants reported feeling more informed about correct antibiotic use and more confident in exploring different treatment methods. These studies reported no major adverse side effects.

The Videoconference Antimicrobial Stewardship Team (VAST) has been implemented at rural Veterans Affairs medical centers to manage antibiotic use. Initial studies showed positive results in reducing antibiotic use without harming patients. Telehealth, which connects healthcare providers and patients through video calls, has proven helpful in areas lacking easy access to infectious disease experts.

Overall, telehealth for managing antibiotic use and preventing resistance has been well-received, with no serious health problems reported among participants. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores innovative strategies to optimize antibiotic use. Unlike traditional methods that might rely heavily on in-person consultations and sporadic feedback, this trial uses a Videoconference Antimicrobial Stewardship Team (VAST) to enhance communication and support. The VAST+ approach is particularly exciting because it adds quarterly facility-level Antibiotic Use Reports, providing detailed insights into antibiotic usage patterns. These features could lead to more tailored and efficient antibiotic stewardship, potentially reducing misuse and resistance.

What evidence suggests that this trial's treatments could be effective for antimicrobial stewardship?

Studies have shown that the Videoconference Antimicrobial Stewardship Team (VAST) effectively reduces unnecessary antibiotic use. Research indicates that implementing VAST at medical centers led to a noticeable drop in antibiotic prescriptions. This approach connects healthcare providers to infectious disease experts through video calls, improving antibiotic use, especially in areas with limited resources. In this trial, some sites will implement VAST alone, while others will receive VAST with quarterly reports on antibiotic use. Initial findings suggest that these quarterly reports enhance the program's effectiveness. Participants in these programs reported increased confidence in treating illnesses correctly. Overall, VAST helps fight antimicrobial resistance by promoting better antibiotic practices. ^{1 2 4 6 7}

Who Is on the Research Team?

Robin Lynn Paige Jump, MD PhD

Principal Investigator

VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA

Charlesnika Tyon Evans, PhD MPH BS

Principal Investigator

Edward Hines Jr. VA Hospital, Hines, IL

Are You a Good Fit for This Trial?

This trial is for VA medical centers lacking local infectious disease (ID) expertise. These centers will partner with an ID expert from another VA facility to implement the program.

Inclusion Criteria

VA medical centers without their own infectious disease (ID) specialist can partner with another VA medical center that has an ID specialist.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Implementation

Implementation of the VAST approach at VAMCs, including randomization to VAST- or VAST+ groups

2.25 years

Follow-up

Participants are monitored for safety and effectiveness after implementation

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Quarterly Reports
• Videoconference Antimicrobial Stewardship Team

Trial Overview The study tests if quarterly reports on antibiotic use can improve a telehealth program called VAST, which aims to reduce unnecessary antibiotic prescriptions at rural VA medical centers by connecting them with distant ID experts.

How Is the Trial Designed?

Group I: VAST+ Experimental Treatment 1 Intervention

Sites that implement the VAST augmented by quarterly facility-level Antibiotic Use Reports (VAST+).

Group II: VAST - Active Control 1 Intervention

to sites that implement the VAST and do NOT receive a quarterly facility-level Antibiotic Use Reports (VAST-).

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Published Research Related to This Trial

The adaptation of an electronic referral application for antimicrobial stewardship significantly increased the completion rate of antimicrobial round reviews from 59% to 88% over 12 months, indicating improved efficiency in the referral process.

There was a notable reduction in the use of broad-spectrum antibiotics, such as piperacillin/tazobactam and fluoroquinolones, alongside a decrease in the proportion of ignored advice from 18% to 8.5%, demonstrating enhanced adherence to clinical recommendations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adaptation of a hospital electronic referral system for antimicrobial stewardship prospective audit and feedback rounds. Rawlins, MDM., Raby, E., Sanfilippo, FM., et al.[2022]

Citations

1. hsrd.research.va.gov hsrd.research.va.gov/research/abstracts.cfm?Project_ID=2141704665

PPO 16-118 – HSR Study - VA Health Systems Research Many participants reported increased awareness of antibiotic stewardship, feeling more confident in treating illnesses differently than in the past, feeling ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12372665/

Dissemination and Implementation of a Telehealth-Enabled ... Telehealth can facilitate improving antibiotic use and related antimicrobial stewardship activities in facilities underserved by infectious diseases (IDs) ...

3. clinicaltrial.be clinicaltrial.be/en/details/175819?per_page=20&recruiting=1&enrolling_by_invitation=1&active_not_recruiting=1&not_yet_recruiting=0&completed=0&only_recruiting=0&only_eligible=0

Dissemination and Implementation of a Videoconference ... Aims are: 1) Identify and test effective strategies for implementing the VAST; 2) Determine the influence of the VAST overall and VAST+ on the ...

4. cambridge.org cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/changes-in-antibiotic-use-following-implementation-of-a-telehealth-stewardship-pilot-program/160FDCAA50FA82FF3E8AD501100537E5

Changes in antibiotic use following implementation of a ... Antibiotic Use Metrics Before and After Implementing the Videoconference Antimicrobial Stewardship Team (VAST). Note. CI, confidence interval ...

5. youtube.com youtube.com/watch?v=_P-fD3XDRoU

Enhancing Antibiotic Stewardship Programs in Critical Access ... During this webinar, speakers will discuss The Joint Commission's upcoming revisions to their antibiotic stewardship standards and highlight ...

6. cambridge.org cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/pilot-study-using-telehealth-to-implement-antimicrobial-stewardship-at-two-rural-veterans-affairs-medical-centers/DA4E18CA0520BE33E710223BB060277C

A pilot study using telehealth to implement antimicrobial ... A pilot study using telehealth to implement antimicrobial stewardship at two rural Veterans Affairs medical centers - Volume 39 Issue 10.

7. researchgate.net researchgate.net/publication/334141088_Changes_in_antibiotic_use_following_implementation_of_a_telehealth_stewardship_pilot_program

Changes in antibiotic use following implementation of a ... Starting in 2016, we initiated a pilot tele-antibiotic stewardship program at 2 rural Veterans Affairs medical centers (VAMCs).