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important factor impacting antibiotic use. Validating the survey responses with measures of actual implementation would be ideal for future studies. Finally, our study did not assess the appro- priateness of antibiotic therapy. This is a labor-intensive activity and presents challenges in cases where appropriateness is uncertain. However, given that an estimated 50% of antibiotic use is inappropriate, a downward trajectory in antibiotic use is likely reflective of reductions in inappropriate use. Despite these limitations, this study offers important considerations for ASPs in hospital settings, including key structural and strategic elements that may reduce inappropriate antimicrobial exposure for patients. In conclusion, wide variability in antibiotic use across hospitals
may be partially explained by ASP characteristics. Both structural elements (ie, designated funding/resources) and strategic elements (ie, prospective audit and feedback, intravenous-to-oral conver- sion) are associated with reduced risk-adjusted antibiotic use.
Financial support. This study was supported by a grant from the Canadian Society of Hospital Pharmacists (CSHP) Foundation.
Conflicts of interest. All authors report no conflicts of interest relevant to this article.
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