EP339 - Identifying Barriers and Facilitators for De-implementation of Antibiotics in Acute Uncomplicated Diverticulitis: A Qualitative Study

ePoster Presenter(s)

• 

  Adam L. Fahey, BS

  Medical Student
  Vanderbilt University School of Medicine
  Vanderbilt University School of Medicine
  Nashville, TN, United States

  Disclosure information not submitted.

Author(s)

• AM

  Amanda S. Mixon, MD, MS, MSPH, FHM

  Associate Professor of Medicine and Biomedical Informatics
  Vanderbilt University Medical Center
  Nashville, Tennessee, United States

  Disclosure information not submitted.
• MW

  Michael Ward, MD, PhD

  Vice Chair for Research
  Vanderbilt University Medical Center
  Nashville, Tennessee, United States

  Disclosure information not submitted.
• KB

  Kemberlee Bonnet, MA

  Senior Research Manager
  Vanderbilt University
  Nashville, Tennessee, United States

  Disclosure information not submitted.
• DS

  David G. Schlundt, PhD

  Associate Professor of Psychology
  Vanderbilt University, Department of Psychology
  Nashville, Tennessee, United States

  Disclosure information not submitted.
• AS

  Alan B. Storrow, MD

  Associate Professor
  Vanderbilt University Medical Center
  Brentwood, Tennessee, United States

  Disclosure information not submitted.
• 

  Danish Ali, MD

  Research Intern
  Vanderbilt University Medical Center
  Nashville, TN, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  Alexander T. Hawkins, MD, MPH

  Associate Professor
  Vanderbilt University Medical Center
  Vanderbilt University Medical Center
  Nashville, TN, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Purpose/Background: Background: Diverticulitis is a common gastroenterological condition with significant symptomatic burden for affected patients. Historically, patients with acute uncomplicated diverticulitis were treated with antibiotics. Recent data suggests antibiotics may be unnecessary for these patients, shifting US clinical guidelines towards an antibiotic-sparing approach. Despite this evidence, there remains a lack of adoption of these guidelines. This single-institution qualitative study identified barriers and facilitators regarding the de-implementation of antibiotics in management of acute uncomplicated diverticulitis.

Methods/Interventions:

Methods: Semi-structured interviews were conducted with both emergency medicine and primary care providers from October to November 2024. Providers were recruited via email with snowball sampling. Demographic data were collected. Interviews focused on personal experience treating patients with acute uncomplicated diverticulitis and perceived barriers and facilitators for de-implementation of antibiotics. Thematic saturation was reached within the sample size. Interviews were transcribed, coded using a hierarchical coding system, and qualitatively analyzed.

Results/Outcomes:

Results: Twenty-six providers were interviewed: 12 from primary care and 14 from emergency medicine. Using the iterative/deductive approach, an integrative model of barriers and facilitators to de-implement the use of antibiotics for acute uncomplicated diverticulitis was developed (Figure 1). Barriers included (1) systemic factors such as lack of proper follow-up, (2) social influences such as patient expectation of antibiotics, and (3) provider factors such as unawareness of guidelines and studies. Facilitators included (1) antibiotic stewardship and (2) clinical pathways to guide treatment decisions.

Conclusion/Discussion:

Conclusion: This study identified actionable barriers and facilitators from the perspective of providers regarding de-implementation of antibiotics for acute uncomplicated diverticulitis. Next steps include the development of de-implementation efforts incorporating these results, including educational sessions for providers, public health initiatives for patients, enhanced clinical pathways to inform treatment decisions, and antibiotic stewardship feedback on prescription patterns.

Figure 1: Integrative model of barriers and facilitators