Background Advanced practice providers (APPs) have taken on increasing responsibilities as primary team members in acute care hospitals, but the impact of this practice shift on antimicrobial prescribing and infectious diseases (ID) consultation requests is unknown. Here we describe longitudinal trends in antimicrobial days of therapy (DOT) and ID consultation by attributed provider type in 3 hospitals. Methods We performed a retrospective time series analysis of antimicrobial use and ID consultation from July 2015 to June 2022 at a major university hospital and 2 community hospitals. We evaluated antimicrobial DOT and ID consultation over time and assessed attribution to 3 groups of providers: attending physicians, trainees, and APPs. We used multinomial logistic regression to measure changes in percentage of DOT and ID consultation across the clinician groups over time using physicians as the referent. Results Baseline distribution of antimicrobial DOT and ID consultation varied by practice setting, but all subgroups showed increases in the proportion attributable to APPs. Large increases were seen in the rate of ID consultation, increasing by >30% during the study period. At our university hospital, by study end >40% of new ID consults and restricted antimicrobial days were attributed to APPs. Conclusions Hospitals had differing baseline patterns of DOT attributed to provider groups, but all experienced increases in DOT attributed to APPs. Similar increases were seen in changes to ID consultation. APPs have increasing involvement in antimicrobial use decisions in the inpatient setting and should be engaged in future antimicrobial stewardship initiatives.

中文翻译：

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转型中的团队：先进实践提供者在抗菌药物使用和传染病咨询中的作用日益增强

背景 高级实践提供者 (APP) 作为急症护理医院的主要团队成员承担着越来越多的责任，但这种实践转变对抗菌药物处方和传染病 (ID) 咨询请求的影响尚不清楚。在这里，我们描述了 3 家医院按归属提供者类型划分的抗菌治疗天数 (DOT) 和 ID 咨询的纵向趋势。方法 我们对 2015 年 7 月至 2022 年 6 月期间在一所主要大学医院和 2 家社区医院的抗菌药物使用和 ID 咨询进行了回顾性时间序列分析。我们评估了抗菌 DOT 和 ID 咨询随时间的变化，并评估了 3 组提供者的归因：主治医生、实习生和 APP。我们使用多项逻辑回归来测量临床医生组中 DOT 和 ID 咨询百分比随时间的变化，并以医生为参考对象。结果 抗菌药物 DOT 和 ID 咨询的基线分布因实践环境而异，但所有亚组均显示 APP 所占比例有所增加。 ID咨询率大幅增加，在研究期间增加了>30%。在我们大学医院，截至研究结束，超过 40% 的新 ID 咨询和抗菌天数限制归因于 APP。结论 各医院的 DOT 基线模式因提供者群体而异，但所有医院的 DOT 均因 APP 而增加。身份证咨询的变化也出现了类似的增长。 APP 越来越多地参与住院环境中抗菌药物使用决策，并应参与未来的抗菌药物管理举措。