Background: Collaborative, interdisciplinary teams—including pharmacists—are critical to optimizing inpatient care. One interdisciplinary role played by clinical pharmacists is antibiotic stewardship. While it’s known that acceptance of stewardship recommendations depends on multiple sociobehavioral factors (e.g., hospital culture, hierarchy, professional autonomy), it’s not known what role gender plays in acceptance of antibiotic stewardship recommendations. Thus, to determine the effect of pharmacist gender on acceptance of antibiotic recommendations by hospitalists, we evaluated the success of a pharmacist-facilitated antibiotic timeout by pharmacist gender.
Methods: Between 5/1/2019—10/31/2019, we conducted a prospective, non–randomized pilot trial of a pharmacist-facilitated antibiotic timeout (i.e., pause with clinical discussion led by pharmacist) prior to discharge to reduce antibiotic overuse at discharge. Prior to the intervention, clinical pharmacists and hospitalists received education and a pocket card outlining appropriate antibiotic treatment at discharge. Discharge antibiotic recommendations were based on national guidelines and encouraged discontinuing unnecessary antibiotics, narrowing broad-spectrum antibiotics, reducing duration, and improving documentation. For all patients anticipated to be discharged on antibiotics, a pharmacist then led an antibiotic timeout in-person (or over the phone if needed) with the hospitalist during afternoon pharmacist/hospitalist rounds. Pharmacists were asked to review antibiotics and recommend changes based on their review of the clinical information. To explore differences in antibiotic timeout effectiveness by pharmacist gender, we used chi-squared tests comparing the proportion of timeouts performed by men vs. women that a) resulted in a recommendation to change antibiotics by a pharmacist and b) resulted in an antibiotic change. A sensitivity analysis was run excluding our two male pharmacist champions.
Results: Between 5/1/2019—10/31/2019, pharmacists conducted 295 antibiotic timeouts. Patient characteristics are shown in Table 1. Over half of timeouts (54%) were conducted by 12 female pharmacists, with the remaining (46%) by 8 male pharmacists. Men and women each completed a similar number of antibiotic timeouts (17 timeouts/man vs. 13 timeouts/woman). Overall, 28% (84/295) of timeouts resulted in a pharmacist recommending an antibiotic change, with male pharmacists more likely to identify a change (42% [58/137] vs 16% [26/158], P< 0.001, Figure 1). When changes were recommended, men had their recommendations accepted 83% (48/58) of the time vs. 38% (10/26) for women (P< 0.001). After excluding two male champions, female pharmacists remained less likely to have their antibiotic recommendations accepted (85% [11/13] men vs. 38% [10/26] women; P=0.006).
Conclusions: In this pilot trial of a discharge antibiotic intervention, antibiotic timeouts conducted by women pharmacists were less likely to result in an antibiotic change than those conducted by men. The difference in intervention effectiveness resulted both from female pharmacists being less likely to recommend a change and from hospitalists being less likely to accept a recommendation from a female pharmacist. These findings suggest gender bias may play a role in acceptance of antibiotic stewardship recommendations, which could impact antibiotic use and patient outcomes.
