Improving antibiotic adherence in treatment of acute upper respiratory infections: a quality improvement process

Introduction: Approximately 25 million people in the United States visit their primary care physician each year for acute respiratory infections (ARI). They are a common cause of unnecessary prescription of antibiotics; despite well-validated national treatment guidelines, around 73% of adults with...

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Main Authors: Rittu Hingorani, Maryam Mahmood, Richard Alweis
Format: Article
Language:English
Published: Taylor & Francis Group 2015-06-01
Series:Journal of Community Hospital Internal Medicine Perspectives
Subjects:
Online Access:http://www.jchimp.net/index.php/jchimp/article/view/27472/pdf_68
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spelling doaj-48e31cbb7a154929a07b45ee8dd9fe912020-11-24T22:24:26ZengTaylor & Francis GroupJournal of Community Hospital Internal Medicine Perspectives2000-96662015-06-01501510.3402/jchimp.v5.2747227472Improving antibiotic adherence in treatment of acute upper respiratory infections: a quality improvement processRittu Hingorani0Maryam Mahmood1Richard Alweis2Internal Medicine Department, Reading Health System, West Reading PA, USAInternal Medicine Department, Reading Health System, West Reading PA, USAInternal Medicine Department, Reading Health System, West Reading PA, USAIntroduction: Approximately 25 million people in the United States visit their primary care physician each year for acute respiratory infections (ARI). They are a common cause of unnecessary prescription of antibiotics; despite well-validated national treatment guidelines, around 73% of adults with ARI are prescribed antibiotics in the United States. Inappropriate use of antibiotics has profound implications. Methods: Our aim was to increase adherence to antibiotic guidelines for treatment of ARI in an internal medicine outpatient practice. We used a package of active and passive interventions to improve physician awareness of treatment guidelines; these included short sessions of didactic teaching, antibiotic guidelines posters in patient examination rooms and staff areas, clinical decision support (CDS) tools integrated into the electronic medical record system, guideline adherence report cards for providers, and reiteration of CDS tool use and guideline adherence at monthly group meetings. Process measures were the rate of use of CDS tools for the management of ARI and patient callbacks within 72 h for the same issue. Outcome measures were compliance with antibiotic prescribing guidelines. Results: Our low-cost interventions led to a significant improvement in ARI treatment guideline adherence. There was improvement in compliance with treatment guidelines for sinusitis (90.90% vs. 57.58%, p<0.001), pharyngitis (64.28% vs. 25.00%, p = 0.003), upper respiratory infection (96.18% vs. 73.68%, p = 0.008), and the aggregated measure of ARI (91.25% vs. 78.6%, p<0.001). Rate of CDS tool usage was 40.5% with a 72-h callback rate of 0.05%. Conclusion: Simple, low-cost interventions can improve appropriate antibiotic use for ARI and change the prescribing habits of providers in an outpatient setting. Provider and patient education is a vital component of antibiotic stewardship. Simple interventions for common outpatient conditions can have a positive impact on patient outcomes and reduce unnecessary healthcare costs.http://www.jchimp.net/index.php/jchimp/article/view/27472/pdf_68antibioticsguidelinesupper respiratory tract infectionsinusitispharyngitisacute respiratory tract infections
collection DOAJ
language English
format Article
sources DOAJ
author Rittu Hingorani
Maryam Mahmood
Richard Alweis
spellingShingle Rittu Hingorani
Maryam Mahmood
Richard Alweis
Improving antibiotic adherence in treatment of acute upper respiratory infections: a quality improvement process
Journal of Community Hospital Internal Medicine Perspectives
antibiotics
guidelines
upper respiratory tract infection
sinusitis
pharyngitis
acute respiratory tract infections
author_facet Rittu Hingorani
Maryam Mahmood
Richard Alweis
author_sort Rittu Hingorani
title Improving antibiotic adherence in treatment of acute upper respiratory infections: a quality improvement process
title_short Improving antibiotic adherence in treatment of acute upper respiratory infections: a quality improvement process
title_full Improving antibiotic adherence in treatment of acute upper respiratory infections: a quality improvement process
title_fullStr Improving antibiotic adherence in treatment of acute upper respiratory infections: a quality improvement process
title_full_unstemmed Improving antibiotic adherence in treatment of acute upper respiratory infections: a quality improvement process
title_sort improving antibiotic adherence in treatment of acute upper respiratory infections: a quality improvement process
publisher Taylor & Francis Group
series Journal of Community Hospital Internal Medicine Perspectives
issn 2000-9666
publishDate 2015-06-01
description Introduction: Approximately 25 million people in the United States visit their primary care physician each year for acute respiratory infections (ARI). They are a common cause of unnecessary prescription of antibiotics; despite well-validated national treatment guidelines, around 73% of adults with ARI are prescribed antibiotics in the United States. Inappropriate use of antibiotics has profound implications. Methods: Our aim was to increase adherence to antibiotic guidelines for treatment of ARI in an internal medicine outpatient practice. We used a package of active and passive interventions to improve physician awareness of treatment guidelines; these included short sessions of didactic teaching, antibiotic guidelines posters in patient examination rooms and staff areas, clinical decision support (CDS) tools integrated into the electronic medical record system, guideline adherence report cards for providers, and reiteration of CDS tool use and guideline adherence at monthly group meetings. Process measures were the rate of use of CDS tools for the management of ARI and patient callbacks within 72 h for the same issue. Outcome measures were compliance with antibiotic prescribing guidelines. Results: Our low-cost interventions led to a significant improvement in ARI treatment guideline adherence. There was improvement in compliance with treatment guidelines for sinusitis (90.90% vs. 57.58%, p<0.001), pharyngitis (64.28% vs. 25.00%, p = 0.003), upper respiratory infection (96.18% vs. 73.68%, p = 0.008), and the aggregated measure of ARI (91.25% vs. 78.6%, p<0.001). Rate of CDS tool usage was 40.5% with a 72-h callback rate of 0.05%. Conclusion: Simple, low-cost interventions can improve appropriate antibiotic use for ARI and change the prescribing habits of providers in an outpatient setting. Provider and patient education is a vital component of antibiotic stewardship. Simple interventions for common outpatient conditions can have a positive impact on patient outcomes and reduce unnecessary healthcare costs.
topic antibiotics
guidelines
upper respiratory tract infection
sinusitis
pharyngitis
acute respiratory tract infections
url http://www.jchimp.net/index.php/jchimp/article/view/27472/pdf_68
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