Safeguarding Health: Addressing the Threat of Antimicrobial Resistance

Antibiotics are one of the most powerful tools in medicine, and most are prescribed in outpatient settings, like doctors’ offices and clinics. However, research has shown that in the United States up to 28 percent of these prescriptions are unnecessary. Unnecessary or inappropriate antibiotic use can allow pathogens to develop the ability to resist the drugs designed to kill them. Drug resistance, or antimicrobial resistance, complicates infection treatment and makes medical procedures like surgery much riskier.

Antibiotic stewardship ensures antibiotics are prescribed at the right dose for the right length of time and provide a clear health benefit. Improving antibiotic use is key to protecting patients, preserving the effectiveness of the drugs and combatting antimicrobial resistance.

While healthcare professionals are responsible for prescribing antibiotics, healthcare payers, including Medicaid agencies, play an important role in tracking antibiotic use. Medicaid agencies maintain patient-level prescribing data without personally identifiable information that can inform antibiotic stewardship priorities. With this data in hand, health departments gain insight into when antibiotics are being prescribed and for what conditions. They can work with Medicaid programs to analyze and share data with clinicians and encourage a responsible approach to antibiotic use.

The Arkansas Department of Health’s Antibiotic Stewardship Program has been actively engaged in this work since 2018. With one of the highest rates of antibiotic use in the country, Arkansas has made enormous strides in addressing the issue. The health department attributes much of their progress to the unique partnership they’ve developed with the state’s Medicaid program.

“We had this huge infrastructural learning of how Medicaid works, how we work and how that can be mutually beneficial,” said Kelley Garner, MPH, epidemiology manager and technical advisor for the Healthcare-Associated and Antibiotic Resistance Infection Program at the Arkansas Department of Health. “We asked, ‘What are your strengths? What are ours? How do we highlight those?’”

With support from The Pew Charitable Trusts, the CDC Foundation partners with the Centers for Disease Control and Prevention (CDC)’s Office of Antibiotic Stewardship to work with state Medicaid programs and health departments, including Arkansas, to encourage collaboration and data sharing. Through bimonthly meetings, nearly 30 health department stewardship teams discuss how to establish and strengthen partnerships with Medicaid agencies. The teams work together, sharing lessons learned, highlighting opportunities and addressing challenges in implementing stewardship activities.

“We take every opportunity to listen to other states who may have learned something unique about how to use this data or how people interact with or accept this data,” said Garner. “We're always learning.”

With this support, Arkansas is now sharing state- and clinic-level trends in antibiotic prescribing with over 175 outpatient clinics, who can use the data to improve the quality of their prescribing. As a result, Arkansas has seen a 22 percent drop in antibiotic prescribing rates in the outpatient clinics that received regular updates on their antibiotic use.

“We're hopeful some of the activities Medicaid has done can be adapted by other insurers, which would expand the reach of our antibiotic stewardship across all parts of our state,” said Garner. "So that’s our next step: figuring out how to talk to the other insurers to see if they can do what Medicaid has done to have an even bigger impact.”

Arkansas’ work is an example of how partnerships strengthen our impact. The CDC Foundation’s Antibiotic Stewardship Resources Project continues to prioritize these partnerships by giving health departments practical tools to work with both Medicaid agencies and clinicians to reduce the risks of antimicrobial resistance.