Improved Antibiotic Use Will Keep People Healthier

Dr. Shantel Hébert-Magee is the Chief Medical Officer of Louisiana Medicaid, and Kolynda Parker is the state’s Medicaid deputy director for program operations and compliance. As part of the leadership team for the Louisiana Department of Health, they work together to improve health outcomes and reduce costs throughout the state. Hébert-Magee and Parker have spearheaded an effort to improve Louisiana’s antibiotic use—which is key to both individual patient care and the broader battle against increasingly drug-resistant superbugs—by adopting antibiotic utilization measures.

This interview has been edited for clarity and length.

What got you interested in public health and clinical quality improvement, and how did you find your way to your current positions?

KP: My work in public service began almost 27 years ago. I’m a clinical lab scientist by training, meaning I was part of a team testing patient samples, and began my career at a charity hospital that served the working poor in Baton Rouge. After graduate school, I wanted to do something different. I spent some time in the private sector and then worked at a critical access hospital before joining the Department of Health. Here I’ve worked in a number of different areas: behavioral health, public health, and now Medicaid.

SHM: I’ve always been interested in the root cause of disease. I wanted to know the impetus—social, environmental, genetic, etc. I worked in medical device development for a long time, then became more interested in public health to make change on a broader level. Initially, I got into public health research with think tanks, and then I worked in public health responses. Trying to address the drivers of disease is fascinating and meaningful to me.

When did you first become aware of the issue of antibiotic resistance—was there a particular moment that put this problem on the radar for you?

KP: It’s hard to remember a time when I wasn’t aware of antibiotic resistance. It was an issue that came up in my first job in the microbiology lab at the charity hospital. And it’s been an important issue in all my professional roles over the years.

SHM: When I had my clinical clerkship in medical school, I remember seeing folks put on hazmat suits to attend to patients with resistant infections and hearing about patients suffering from drug toxicity as a result of being on so many antibiotics. That’s when I realized that resistant infections might not be as rare as I thought.

How has Louisiana Medicaid approached improving antibiotic prescribing within the state?

KP: One of our key strategies has been integrating antibiotic-use metrics into the list of quality-of-care performance measures we require Medicaid providers to report. So far, we’ve added three antibiotic use measures, including the new Antibiotic Utilization for Respiratory Conditions (AXR), that give us information about the frequency and type of antibiotics being prescribed for common diagnoses such as bronchitis and other respiratory conditions. These standardized measures are established by the National Committee for Quality Assurance as part of their Healthcare Effectiveness Data and Information Set and used widely by health care organizations across the country. This allows us to compare antibiotic use not just across Louisiana’s Medicaid providers but also against similar populations, states, and national benchmarks.

What was the process for integrating the new AXR measure into Louisiana’s quality strategy?

KP: We evaluate our quality strategy annually, and Dr. Hébert-Magee leads that process as chair of the Medicaid Medical Advisory Committee. Together with the committee, we review the data, get stakeholder input, and determine whether any changes should be made to the metrics we’re using. We then make updates accordingly.

SHM: While the process is under my purview, it’s not a unilateral decision—the collaborative approach and focus on the data is imperative. When it came to the antibiotic-use measures, many members of the committee—which includes a wide variety of health care professionals, such as neonatologists, pediatricians, and long-term care providers—had previous experience using these types of metrics, had seen their value firsthand, and were very receptive overall. Our decision to integrate the new measures also sparked some important conversations about complementary efforts also needed to help improve prescribing, like provider and patient education, so we’re working on that as well.

How do the state’s efforts to improve antibiotic prescribing benefit Louisianans?

SHM: First, better patient outcomes. Then, fiscal benefits. Improved antibiotic use means keeping people healthier, more effective treatment, and reduced side effects. It’s essential to person-centered care, and it also saves money.

Are these benefits well understood by the public?

SMH: I think we have more work to do in educating health care providers and patients about when antibiotics are helpful and when they’re not. For providers, it can be hard to turn away a parent who has a sick kid without giving them something. And for parents, they understandably want to help their child feel better. I get that. But prescribing an antibiotic for a cold or other viral infection, for example, carries more potential risks than benefits.

We need to find ways to build the provider-patient rapport and foster trust, so that when medical professionals are having conversations about when and why an antibiotic might not be helpful, patients and their families are open to receiving that message.

What would you say to other states that haven’t started using antibiotic measures yet?

KP: I would say that if you don’t measure, you can’t monitor. You don’t know what you don’t know. I would encourage other states to at least incorporate the antibiotic use measures and see what the data reveals as a starting place.

SHM: I agree. And it’s a relatively easy lift for a lifesaving impact. Taking steps to improve antibiotic use affects the health of people today, and it’s also essential to preserving the effectiveness of these drugs for all of society. Antibiotics have expanded our lifespans significantly over the past century—it would be terrible to lose these drugs. It’s very scary to think about.