Jefferson G Bohan1, Karl Madaras-Kelly2, Benjamin Pontefract2, Makoto Jones3, Melinda M Neuhauser4, Matthew Bidwell Goetz5, Muriel Burk6, Francesca Cunningham6. 1. Department of Pharmacy,Ochsner Health System,New Orleans, Louisiana. 2. Pharmacy Service,Boise Veterans Affairs Medical Center,Boise, Idaho. 3. IDEAS Center,Veterans Affairs Salt Lake City Healthcare System,Salt Lake City, Utah. 4. Veterans Affairs Pharmacy Benefits Management Services,Hines, Illinois. 5. Department of Infectious Diseases,Veterans Affairs Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA,Los Angeles, California. 6. Center for Medication Safety (VAMedSAFE),Hines Veterans Affairs Medical Center,Chicago, Illinois.
Abstract
BACKGROUND: Antibiotics are overprescribed for acute respiratory tract infections (ARIs). Guidelines provide criteria to determine which patients should receive antibiotics. We assessed congruence between documentation of ARI diagnostic and treatment practices with guideline recommendations, treatment appropriateness, and outcomes. METHODS: A multicenter quality improvement evaluation was conducted in 28 Veterans Affairs facilities. We included visits for pharyngitis, rhinosinusitis, bronchitis, and upper respiratory tract infections (URI-NOS) that occurred during the 2015-2016 winter season. A manual record review identified complicated cases, which were excluded. Data were extracted for visits meeting criteria, followed by analysis of practice patterns, guideline congruence, and outcomes. RESULTS: Of 5,740 visits, 4,305 met our inclusion criteria: pharyngitis (n = 558), rhinosinusitis (n = 715), bronchitis (n = 1,155), URI-NOS (n = 1,475), or mixed diagnoses (>1 ARI diagnosis) (n = 402). Antibiotics were prescribed in 68% of visits: pharyngitis (69%), rhinosinusitis (89%), bronchitis (86%), URI-NOS (37%), and mixed diagnosis (86%). Streptococcal diagnostic testing was performed in 33% of pharyngitis visits; group A Streptococcus was identified in 3% of visits. Streptococcal tests were ordered less frequently for patients who received antibiotics (28%) than those who did not receive antibiotics 44%; P < .01). Although 68% of visits for rhinosinusitis had documentation of symptoms, only 32% met diagnostic criteria for antibiotics. Overall, 39% of patients with uncomplicated ARIs received appropriate antibiotic management. The proportion of 30-day return visits for ARI care was similar for appropriate (11%) or inappropriate (10%) antibiotic management (P = .22). CONCLUSIONS: Antibiotics were prescribed in most uncomplicated ARI visits, indicating substantial overuse. Practice was frequently discordant with guideline diagnostic and treatment recommendations.
BACKGROUND: Antibiotics are overprescribed for acute respiratory tract infections (ARIs). Guidelines provide criteria to determine which patients should receive antibiotics. We assessed congruence between documentation of ARI diagnostic and treatment practices with guideline recommendations, treatment appropriateness, and outcomes. METHODS: A multicenter quality improvement evaluation was conducted in 28 Veterans Affairs facilities. We included visits for pharyngitis, rhinosinusitis, bronchitis, and upper respiratory tract infections (URI-NOS) that occurred during the 2015-2016 winter season. A manual record review identified complicated cases, which were excluded. Data were extracted for visits meeting criteria, followed by analysis of practice patterns, guideline congruence, and outcomes. RESULTS: Of 5,740 visits, 4,305 met our inclusion criteria: pharyngitis (n = 558), rhinosinusitis (n = 715), bronchitis (n = 1,155), URI-NOS (n = 1,475), or mixed diagnoses (&gt;1 ARI diagnosis) (n = 402). Antibiotics were prescribed in 68% of visits: pharyngitis (69%), rhinosinusitis (89%), bronchitis (86%), URI-NOS (37%), and mixed diagnosis (86%). Streptococcal diagnostic testing was performed in 33% of pharyngitis visits; group A Streptococcus was identified in 3% of visits. Streptococcal tests were ordered less frequently for patients who received antibiotics (28%) than those who did not receive antibiotics 44%; P &lt; .01). Although 68% of visits for rhinosinusitis had documentation of symptoms, only 32% met diagnostic criteria for antibiotics. Overall, 39% of patients with uncomplicated ARIs received appropriate antibiotic management. The proportion of 30-day return visits for ARI care was similar for appropriate (11%) or inappropriate (10%) antibiotic management (P = .22). CONCLUSIONS: Antibiotics were prescribed in most uncomplicated ARI visits, indicating substantial overuse. Practice was frequently discordant with guideline diagnostic and treatment recommendations.
Authors: Benjamin Pontefract; Mckenna Nevers; Katherine E Fleming-Dutra; Adam Hersh; Matthew Samore; Karl Madaras-Kelly Journal: Open Forum Infect Dis Date: 2019-10-04 Impact factor: 3.835
Authors: Ebbing Lautenbach; Keith W Hamilton; Robert Grundmeier; Melinda M Neuhauser; Lauri A Hicks; Anne Jaskowiak-Barr; Leigh Cressman; Tony James; Jacqueline Omorogbe; Nicole Frager; Muida Menon; Ellen Kratz; Lauren Dutcher; Kathleen Chiotos; Jeffrey S Gerber Journal: Open Forum Infect Dis Date: 2022-06-06 Impact factor: 4.423
Authors: Suzette A Rovelsky; Richard E Remington; McKenna Nevers; Benjamin Pontefract; Adam L Hersh; Matthew Samore; Karl Madaras-Kelly Journal: J Am Coll Emerg Physicians Open Date: 2021-06-16