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Evaluation of uncomplicated acute respiratory tract infection management in veterans: A national utilization review.

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.

journal_name

Infect Control Hosp Epidemiol

journal_title

Infection control and hospital epidemiology

authors

Bohan JG,Madaras-Kelly K,Pontefract B,Jones M,Neuhauser MM,Bidwell Goetz M,Burk M,Cunningham F,ARI Management Improvement Group.

doi

10.1017/ice.2019.16

subject

Has Abstract

pub_date

2019-04-01 00:00:00

pages

438-446

issue

eissn

0899-823X

issn

1559-6834

pii

S0899823X19000163

journal_volume

pub_type

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Evaluation of uncomplicated acute respiratory tract infection management in veterans: A national utilization review.