“It is wonderful that the Agency for Healthcare Research and Quality offers funding focusing on patient safety, particularly for underserved populations.  With AHRQ’s help, my goal is to improve antibiotic use and minimize antimicrobial resistance.”

Antibiotic stewardship is vitally important to both individual and public health because inappropriate antibiotic use can lead to antibiotic-resistant bacteria, which can make antibiotics ineffective.  Larissa Grigoryan, M.D., Ph.D., is focusing her AHRQ-funded research on reducing the inappropriate use of antibiotics, specifically in outpatient care.  Dr. Grigoryan, an associate professor of family and community medicine at Baylor College of Medicine, is developing and testing antibiotic stewardship interventions, making healthcare safer.  Unsafe antibiotic use includes using antibiotics without a prescription, which could mean using another person’s medication or using your own leftover antibiotics.  Using antibiotics inappropriately—for instance, not finishing all doses prescribed—leads to increased antibiotic resistance and adverse drug reactions.

In 2019, Dr. Grigoryan began serving as a co-principal investigator on a 5-year AHRQ grant to explore why nonprescription antibiotic use occurs.  The study focused on low-income patients seen at safety-net primary care clinics, where uninsured and other vulnerable patients receive healthcare.  Dr. Grigoryan collaborated with AHRQ grantee Barbara Trautner, M.D., Ph.D., in conducting this study.  They found a lack of health insurance, high cost of doctor visits, and lack of transportation for medical appointments were primary reasons people used antibiotics without a prescription.

Building on her antibiotic stewardship research, Dr. Grigoryan served as a co-principal investigator on a 2-year AHRQ grant in 2020 to study the prevalence and predictors of antibiotic use without a prescription in children.  The study found that educating people on the appropriate use of antibiotics shows promise to decrease nonprescription antibiotic use.  During testing of the educational materials, the research team found that people liked information on alternative ways to treat different symptoms and conditions.  Many had been unaware of any negative effects, such as antibiotic resistance and adverse drug reactions, from the unsafe use of antibiotics.  They also found participants appreciated information on alterative remedies that reduce the need for antibiotics.  Results of the study are guiding development of an educational intervention.

Currently, Dr. Grigoryan is tackling the overprescribing of antibiotics from a different angle: the misdiagnoses of urinary tract infections (UTIs).  She is the lead investigator on a 5-year AHRQ grant awarded in 2023.  The aim of this project is to create a program that will educate patients on the correct method for collecting urine to be used for a culture—a test healthcare providers use to check for UTIs.  This project focuses on low-income patients without health insurance.  The team has designed and is testing a short, animated educational video and flyer.  Both the video and flyer are being created in English and Spanish.  If the project succeeds in reducing contaminated urine cultures, this will help reduce unnecessary antibiotic use, slow the emergence of antimicrobial resistance, and preserve the effectiveness of antibiotics for current and future generations.  It will also reduce waste of laboratory resources, decreasing costs for both patients and healthcare institutions.  This project will end May 31, 2028.

“I’m so grateful to AHRQ for the ability to do this kind of work,” said Dr. Grigoryan, who is also an investigator for the Center for Innovations in Quality, Effectiveness and Safety at the Michael E. DeBakey VA Medical Center in Houston.  “Without AHRQ’s support, we wouldn’t have an opportunity to carry out these projects.”

Related AHRQ Resources

Toolkit To Improve Antibiotic Use in Ambulatory Care