Interventions to Influence the Use of Antibiotics for Acute Upper Respiratory Tract Infections

Thompson, Wade; McCormack, Suzanne

doi:10.51731/cjht.2021.37

Cited by 4 publications

(4 citation statements)

References 25 publications

(237 reference statements)

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“…The development and application of quality measures to virtual care providers may improve guideline adherence and reduce practice variability, as it has in some cases for in-person encounters. 15,16 Our findings suggest there is a significantly higher rate of antibiotic prescribing in ARI among vendor-supplied providers when compared to system-employed, board-certified EPs. Further study of downstream care (either for adverse drug events or missed bacterial infections) may reveal consequences of this practice variation, but its presence suggests an opportunity and need for quality review as unscheduled acute virtual care assumes a prominent role in healthcare delivery.…”

Section: Discussionmentioning

confidence: 75%

Differences in antibiotic prescribing rates for telemedicine encounters for acute respiratory infections

Ngai

Genes

2022

J Telemed Telecare

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Introduction Health systems are increasingly implementing direct-to-consumer telemedicine for unscheduled acute care, however quality of care may be variable. Acute respiratory infection antibiotic prescribing rates in telemedicine visits performed by emergency physicians affiliated with medical centers has not been compared to care by unaffiliated, vendor-supplied physicians (a heterogeneous group). We hypothesized that, in virtual visits for acute respiratory infection, affiliated physicians would prescribe antibiotics at a lower rate than unaffiliated physicians. Methods We performed a retrospective analysis of on-demand telemedicine visits available to health system employees and dependents at a large urban academic health system from March 2018 to July 2019. We performed multivariable logistic regression to determine the effect of physician affiliation on antibiotic prescribing patterns for acute respiratory infection, adjusting for patient age, visit weekday, and overnight visits. Results Of 257 telemedicine encounters related to acute respiratory infection, affiliated physicians prescribed antibiotics in 18% of visits, compared to 37% of visits by vendor physicians. In multivariable analysis, patients seen by a vendor physician for acute respiratory infection had 2.3 higher odds (95%CI 1.1–4.5, p < 0.01) of being prescribed antibiotics, an average marginal effect of 15% (95%CI 2–29%). Discussion In this study of virtual visits for unscheduled acute care in a single health system, vendor-supplied physicians were predicted to prescribe an antibiotic in 15% more acute respiratory infection visits compared to system-employed emergency physicians (35% vs 19%). Physician affiliation and familiarity with a health system, in addition to other factors, may be important in guideline adherence and antibiotic stewardship in direct-to-consumer telemedicine encounters.

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Section: Discussionmentioning

confidence: 75%

Differences in antibiotic prescribing rates for telemedicine encounters for acute respiratory infections

Ngai

Genes

2022

J Telemed Telecare

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“…Physicians often prescribe antibiotics inappropriately when faced with time pressures and patient demands despite their preference for evidence-based practice. Clinical decision support tools, guidelines and patient education programs could help reduce unnecessary antibiotic use [ 37 , 38 , 45 , 46 ]. POCT may enormously facilitate the proper diagnosis and management of viral disorders.…”

Section: Discussionmentioning

confidence: 99%

Positive Point-of-Care Influenza Test Significantly Decreases the Probability of Antibiotic Treatment during Respiratory Tract Infections in Primary Care

Rzepka¹,

Mania

2023

Diagnostics

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This study aimed to analyse clinical and laboratory findings in primary care patients with respiratory tract infections to distinguish the group more likely to receive antibiotic treatment. The study group consisted of 631 patients (264 males; 367 females) with a median age of 48 years (IQR 36–63 years). Analysed groups included patients treated with antibiotics (n = 269 patients; 43%) and those who recovered without antibiotic treatment (n = 362 patients; 57%). Patients receiving antibiotics were older (median 51 vs. 47 years; p = 0.008) and more commonly developed fever (77% vs. 25%, p < 0.0001) and cough (63% vs. 30%; p = 0.0014). Moreover, they more frequently presented wheezing and crackles upon physical examination (28% vs. 4% and 9% vs. 0.3%; p < 0.0001 and p < 0.0001, respectively). They also had more comorbidities and came to more follow-up visits (median of 4 vs. 3 and 2 vs. 1, p < 0.0001 and p < 0.0001, respectively). Patients receiving symptomatic therapy more often had positive point-of-care tests (POCTS)—20% vs. 7%; p = <0.0001. Multivariate analysis in our cohort found comorbidities complexity (odds ratio—OR 2.62; 95% confidence interval—1.54–4.46), fever (OR 32.59; 95%CI 19.15–55.47), crackles (OR 26.35; 95%CI 2.77–250.81) and the number of visits (OR 4.15; 95%CI 2.39–7.20) as factors increasing the probability of antibiotic treatment. Positive influenza POCTS reduced the risk of antibiotic therapy (OR 0.0015; 95%CI 0.0001–0.0168).

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“…These include delayed (postdated) antibiotic prescriptions and different interventions to guide the use of antibiotics, as well as multiple educational strategies. 2 Prescription pattern evaluation is a part of the process of improving patient care by reviewing the existing prescribing practices. It helps to assess the extent and pattern of inappropriate antibiotic use and extent of polypharmacy in a health care setting and provide a platform for implementation of necessary changes.…”

mentioning

confidence: 99%

Appropriateness of antibiotic prescribing for upper respiratory tract infection in a tertiary care teaching hospital: a cross sectional study

Shah

Trivedi²,

Chauhan³

2023

Int J Basic Clin Pharmacol

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Background: Overuse of antibiotics among the patients with upper respiratory tract infection (URTI) is a worldwide problem, leading to antimicrobial resistance. This study is aimed to evaluate the appropriateness of the antimicrobial prescribing for upper respiratory tract infections in a tertiary care teaching hospital. Methods: This was a cross-sectional, observational study. Data was collected from outdoor adult patients who were clinically diagnosed to have URTIs from General Medicine and Otorhinolaryngology Department of a tertiary care teaching hospital. The appropriateness of antibiotics used in URTI was assessed. The data was analyzed using descriptive statistics. Results: Total 100 cases, clinically diagnosed to have URTI were included in the study. Among these, common cold (46%) and acute otitis media (23%) were the most frequent encounters. 75% of the prescriptions contained at least one antibiotic. In fact, antibiotics were the most commonly prescribed agents (21.2%) followed by antihistaminic (19.8%) and NSAIDs. 57% of the antibiotics were prescribed inappropriately, either in terms of inappropriate choice (37%) or over use (20%) of antibiotic. Conclusions: Inappropriate prescription of antibiotics for otherwise self-limiting URTI cases is a common practice even in a tertiary care teaching hospital. Implementation of multifaceted approach is needed to curtail the same.

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Interventions to Influence the Use of Antibiotics for Acute Upper Respiratory Tract Infections

Cited by 4 publications

References 25 publications

Differences in antibiotic prescribing rates for telemedicine encounters for acute respiratory infections

Differences in antibiotic prescribing rates for telemedicine encounters for acute respiratory infections

Positive Point-of-Care Influenza Test Significantly Decreases the Probability of Antibiotic Treatment during Respiratory Tract Infections in Primary Care

Appropriateness of antibiotic prescribing for upper respiratory tract infection in a tertiary care teaching hospital: a cross sectional study

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