Antibiotic prescription for acute rhinosinusitis: Emergency departments versus primary care providers

Bergmark, Regan W.; Sedaghat, Ahmad R.

doi:10.1002/lary.26001

Cited by 13 publications

(14 citation statements)

References 17 publications

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“…Our findings suggested that poor access may have a greater impact on ED use for ARS by Medicaid, rather than the quality of care they receive at PCP offices. Looking at more than 37 million PCP and ED visits for uncomplicated ARS, we also found no differences in antibiotic prescribing patterns between the outpatient PCP and ED settings, and likewise found no differences in prescribing patterns by insurance status, for pediatric and adult patients . These findings suggested that patients’ expectation for a specific treatment likely does not drive disparate ED utilization either for ARS.…”

Section: Introductionmentioning

confidence: 53%

Disparities in health in the United States: An overview of the social determinants of health for otolaryngologists

Bergmark

Sedaghat

2017

Laryngoscope Investig Oto

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ObjectivesSocial determinants of health include social and demographic factors such as poverty, education status, race and ethnicity, gender, insurance status, and other factors that influence (1) development of illness, (2) ability to obtain and utilize healthcare, and (3) health and healthcare outcomes. In otolaryngology, as in other subspecialty surgical fields, we are constantly confronted by patients’ social and demographic circumstances including poverty, language barriers, and lack of health insurance and yet there is limited research on how these factors impact health equity in our field, or how attention to these patient characteristics may improve health equity. This review provides the reader with a framework to understand the social determinants of health including how socioeconomic status, insurance status, race, gender, and other factors impact health.Data Sources and Review MethodsFoundational papers on the social determinants of health are reviewed, as well as otolaryngology publications focused on health and healthcare disparities.ResultsThe social determinants of health have a major impact on patient health as well as healthcare utilization, but there is a relative lack of data on these factors and how they can be addressed within otolaryngology. Incorporating tools to measure social and demographic characteristics and actually report on these measures is a first simple step to increase the data on the social determinants of health as they pertain to otolaryngology.ConclusionMore research is needed on the social determinants of health, and how they impact otolaryngic disease. Medicare's Accountable Care Organization models will increasingly change the way in which physicians are reimbursed, making the social determinants of health central not only to our moral conscience but also the bottom line.Level of Evidence4

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Section: Introductionmentioning

confidence: 53%

Disparities in health in the United States: An overview of the social determinants of health for otolaryngologists

Bergmark

Sedaghat

2017

Laryngoscope Investig Oto

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“…Acute and chronic rhinosinusitis are the most frequent diagnoses associated with antibiotic prescription at outpatient physician visits, 7,12 with nearly 60% of visits associated with rhinosinusitis resulting in prescription of an antibiotic. 13 We previously have found that the frequency of acute CRS exacerbations is significantly associated with decreased general health-related QoL in a manner independent of the direct effects of chronic sinonasal symptoms. 3 CRS-related systemic medication use therefore may be an important indicator of the QoL of CRS patients that can easily be queried and utilized in both the clinical and research settings.…”

Section: Introductionmentioning

confidence: 90%

“…Although the mainstay of CRS maintenance medical therapy consists of saline nasal irrigations and topical intranasal corticosteroids that target sinonasal inflammation, CRS exacerbations frequently are treated with systemic medications, including oral antibiotics and corticosteroids. Acute and chronic rhinosinusitis are the most frequent diagnoses associated with antibiotic prescription at outpatient physician visits, with nearly 60% of visits associated with rhinosinusitis resulting in prescription of an antibiotic . We previously have found that the frequency of acute CRS exacerbations is significantly associated with decreased general health‐related QoL in a manner independent of the direct effects of chronic sinonasal symptoms .…”

Section: Introductionmentioning

confidence: 99%

Association between systemic antibiotic and corticosteroid use for chronic rhinosinusitis and quality of life

et al. 2017

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Objective: We sought to establish the significance of querying chronic rhinosinusitis (CRS) patients about their past CRS-related oral antibiotic and corticosteroid usage by determining the association between these metrics and patients' quality of life (QoL).Study Design: Cross-sectional study.Methods: A total of 157 patients with CRS were prospectively recruited. CRS-specific QoL was measured using the 22-item Sinonasal Outcome Test . General health-related QoL was measured using the EuroQoL five-dimensional questionnaire visual analog scale. Associations were sought between these measures of QoL and frequency of CRS-related oral antibiotic and corticosteroid usage reported by the participants in the prior 3 and 12 months.Results: More frequent antibiotic and corticosteroid use was significantly associated with worse CRS-specific and general health-related QoL, whether querying medication use over the prior 3 months or over the prior 12 months (P < 0.001 in all cases). The effect size of CRS-related antibiotic use during the prior 3 months on CRS-specific QoL (SNOT-22 score) was significantly greater than for use during the prior 12 months. However, there was no other statistically significant difference in effect size for association between QoL and CRS-related antibiotic or corticosteroid use in the prior 3 months versus prior 12 months. These results were independent of the presence or absence of polyps.Conclusion: More frequent past CRS-related oral antibiotic and corticosteroid use, regardless of time period queried (3 months or 12 months) is associated with significant decrease in CRS-specific and general health-related QoL. CRS-related systemic medication use is an important indicator of CRS patients' QOL that easily can be queried and utilized in both clinical and research settings.

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“…We previously have found that for uncomplicated acute rhinosinusitis (ARS)—a common condition with more than 20 million cases annually in the United States—patients with Medicaid or self‐pay insurance status disproportionately are more likely to present to an emergency department (ED) for ARS versus privately insured patients . Children and adults suffering from ARS may seek care at an ED or primary care provider (PCP); in both cases, over 50% of adult and pediatric ARS patients receive an antibiotic independent of insurance status . Children of lower socioeconomic status are at a higher risk for intracranial complications of ARS .…”

Section: Introductionmentioning

confidence: 99%

“…5 Children and adults suffering from ARS may seek care at an ED or primary care provider (PCP); in both cases, over 50% of adult and pediatric ARS patients receive an antibiotic independent of insurance status. 6 Children of lower socioeconomic status are at a higher risk for intracranial complications of ARS. 7 Also, like adults, pediatric patients with Medicaid/CHIP have been shown to have problems with access to both primary care and specialty care when compared to patients with private insurance.…”

Section: Introductionmentioning

confidence: 99%

Emergency department use for acute rhinosinusitis: Insurance dependent for children and adults

et al. 2017

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Antibiotic prescription for acute rhinosinusitis: Emergency departments versus primary care providers

Abstract: 4. Laryngoscope, 126:2439-2444, 2016.

Cited by 13 publications

References 17 publications

Disparities in health in the United States: An overview of the social determinants of health for otolaryngologists

Disparities in health in the United States: An overview of the social determinants of health for otolaryngologists

Association between systemic antibiotic and corticosteroid use for chronic rhinosinusitis and quality of life

Emergency department use for acute rhinosinusitis: Insurance dependent for children and adults

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