Telehealth Connects Rural Medical Centers with Infectious Disease Experts to Improve Antibiotic Prescribing

June 23, 2026

Takeaway: New studies highlight how telemedicine can support antimicrobial stewardship programs at rural VA hospitals. Results of one study found that more than 90% of rural healthcare professionals reported that implementing a video antimicrobial stewardship team (VAST) improved the quality of Veteran care. Through QUERI, VAST is being disseminated at more rural VA facilities.

Background

Antimicrobial stewardship guidelines require a multidisciplinary team with an infectious disease (ID) physician and ID-trained clinical pharmacist as core members. Unfortunately, there are not enough ID-trained specialists to staff onsite antimicrobial stewardship programs. Telehealth can facilitate improving antibiotic use and related antimicrobial stewardship activities in facilities underserved by ID expertise by connecting rural VA medical centers with infectious disease experts to improve antibiotic prescribing.

Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antibiotics to reduce microbial resistance. Antibiotics are powerful medicines that fight bacterial infections, but the overuse and misuse of antibiotics have contributed to antibiotic resistance. According to the CDC, more than 2.8 million antimicrobial-resistant infections occur in the United States every year, with more than 35,000 deaths occurring as a direct result.

In a study led by HSR investigators Robin Jump, MD, PhD, and Charlesnika Evans, PhD, MPH, a videoconference antimicrobial stewardship team (VAST) was implemented at 10 rural VA medical centers (VAMCs) from September 2021 to February 2024. VASTs provided regular meetings between rural VAMCs and an off-site infectious disease expert, who met by videoconference, to discuss clinical cases, emphasizing recommendations for antibiotic prescribing. Study results showed that VASTs have been successful in supporting antimicrobial stewardship activities at VAMCs that do not have ID-trained physicians or pharmacists on staff.

The time and effort required of the antimicrobial stewardship champions (i.e., pharmacists, infection preventionists) at the rural VAMCs and the ID consultants to participate in VASTs, however, had not been previously described. Thus, in another study, Drs. Jump and Evans, and colleagues, assessed workload estimates based on the time ID consultants and antimicrobial stewardship champions at rural VAMCs were allocated to VAST activities.

Study findings suggest that from an organizational perspective, allocating up to 13% FTEs (full-time employees) from the antimicrobial stewardship program of a rural VAMC to support an ID consultant at a geographically distant VAMC would offer a cost-effective approach to sustaining VASTs.

Implications

These new studies highlight how telemedicine can support antimicrobial stewardship programs at rural VA hospitals. Results of one study found that more than 90% of rural healthcare professionals reported that implementing a video antimicrobial stewardship team (VAST) improved the quality of Veteran care. Through QUERI, VAST is being disseminated at more rural VA facilities.

Partners

VA's Quality Enhancement Research Initiative (QUERI).

Investigators

Charlesnika T. Evans, PhD, MPH, an HSR Senior Research Career Scientist, is a core investigator with HSR's Center of Innovation for Complex Chronic Healthcare (CINCCH). Robin Jump, MD, PhD, was an affiliate investigator with HSR's Center for Healthcare Evaluation, Research, and Promotion (CHERP) during this study, and an Associate Director for the Technology Enhancing Healthcare & Cognition-Geriatric Research Education & Clinical Center (GRECC); she is currently part of the VA Northeast Ohio Healthcare System.

Citations

Bej TA, Milner AL, Nguyen A, et al. Recommendations made and accepted by a telehealth-enabled Antimicrobial Stewardship program implemented at rural Veterans Affairs medical centers. Infection Control & Hospital Epidemiology. Published online: May 4, 2026.

Vivo A, Wilson GM, French DD, et al. Staffing and workflow of an interactive telehealth Antimicrobial Stewardship program with the Veterans Health Administration. Infection Control & Hospital Epidemiology. Published online: May 4, 2026.

Jump R, Bej T, Vivo A, et al., and Evans C. Dissemination and implementation of a telehealth-enabled program for providing infectious disease expertise in rural settings. Open Forum Infectious Diseases. August 11, 2025;12(8):ofaf485.