Use of antibiotics for adult upper respiratory infections in outpatient settings: a national ambulatory network study.

BACKGROUND AND OBJECTIVES: Studies have suggested that antibiotics are often inappropriately used in the treatment of acute upper respiratory tract infections (URIs). This study examined antibiotic use for adult URIs in a large national network of offices that use electronic health records (EHRs). METHODS: Using the Medical Quality Improvement Consortium (MQIC) database, URI episodes were identified for patients ages 18 to 65 years from January 1, 1998, to March 31, 2003. The percentage of episodes for which antibiotics were prescribed and the proportion of antibiotics that were broad spectrum were calculated. RESULTS: Of the 52,135 URI episodes identified, 65% received antibiotics. Antibiotics were prescribed for 78% of acute bronchitis episodes, 65% of acute pharyngitis episodes, 81% of acute sinusitis episodes, and 33% of nonspecific URI episodes. The proportion of antibiotics that were broad spectrum was 56% for all URI episodes, 68% for acute bronchitis, 55% for acute sinusitis and nonspecific URI, and 40% for pharyngitis. CONCLUSIONS: This study demonstrates overuse of antibiotics for adult URIs in a large national ambulatory care network, with particular overuse of broad-spectrum antibiotics. The study also illustrates the enormous potential of EHR data for conducting practice-based research across large national office networks.

Do physicians in Delaware follow national guidelines for tobacco counseling?

BACKGROUND: Despite national guidelines, studies across the country have shown that many physicians do not regularly engage in tobacco cessation behaviors such as assisting their patients with quitting. This survey study examined tobacco cessation behaviors among physicians in Delaware as part of the state's tobacco control program called Plan for a Tobacco-Free Delaware. METHODS: A self-administered questionnaire was mailed to all Delaware physicians in primary care and specialties that manage tobacco-related illnesses (cardiology, pulmonology, and allergy) in May of 2002 (n=890). RESULTS: Of the 156 survey respondents, most physicians reported regularly asking their adolescent patients (57.3%) and their adult patients (65.4%) about smoking and advising their smoking patients to quit (84%). Most physicians do not regularly assist patients in quitting (17.6%) or arrange follow-up (28.1%). Also, most physicians do not regularly prescribe nicotine replacement (12.9%) or bupropion (10.7%), nor do they regularly give written materials to help in quitting (16.3%) or refer patients to smoking cessation programs (14.7%). CONCLUSIONS: While most physicians in Delaware ask their patients about smoking and advise them to quit, most physicians do not adequately assist their smoking patients in accordance with national guidelines. Reasons include lack of time, lack of quick and easy tools to help patients quit, and inadequate reimbursement for physicians' tobacco cessation activities and medications. This article suggests ways that the state can assist physicians with tobacco cessation that can be incorporated into the Plan for a Tobacco-Free Delaware. In particular, ensuring adequate and universal reimbursement for physician visits related to tobacco cessation, for tobacco cessation programs, and for tobacco cessation medications is essential to increasing physician involvement in tobacco cessation activities.