Overprescribing rates remain high for pharyngitis, bronchitis
SAN FRANCISCO — Despite the efforts of antimicrobial stewardship programs, data presented here indicate that physicians continue to overprescribe for common viral conditions.
Physicians prescribed antibiotics for 60% of visits for pharyngitis and 73% of visits for acute bronchitis. The antibiotic prescribing rate should be about 10% for pharyngitis and about 0% for acute bronchitis, according to Jeffrey A. Linder, MD, MPH, of Harvard Medical School and Brigham and Women’s Hospital, and Ed Septimus, MD, of Texas A&M Health Science Center in Houston, who both spoke during an ID Week 2013 press conference.
Jeffrey A. Linder
To assess the antibiotic prescribing rate for pharyngitis, Linder and Michael Barnett, MD, a resident at Brigham and Women’s Hospital, determined there were 94 million visits to primary care physicians and EDs for pharyngitis between 1997 and 2010, based on an extrapolation of nearly 8,200 visits. Physicians prescribed antibiotics 60% of the time, a decrease from 73% from numbers reported by the same researchers in 2001.
“I would characterize that as moderate to marginal improvement and painfully slow. This is very far away from the ideal prescribing rate,” Linder said during a press conference.
Based on the cost analysis, these rates also translate into increased costs, totaling $500 million to $20 billion in overall costs for unnecessary antibiotics for pharyngitis, Linder said.
Regarding acute bronchitis, Linder and colleagues calculated that 39 million visits to PCPs and EDs between 1996 and 2
010, based on extrapolation of more than 3,600 visits. This indicates a significant increase in the number of visits for acute bronchitis to PCPs — from 1.1 million in 1996 to 3.4 million in 2010. An increase in the antibiotic prescribing rate in EDs also occurred during the same period, from 69% to 73%.
The good news is that younger physicians have better prescribing rates, but “we still have a long way to go,” Linder told Infectious Disease News.
As for ways to reduce unnecessary prescribing, education is the primary focus, but communication between physicians and patients and setting patient expectations is key.
Septimus said there is a fear by physicians that patients may leave their practice dissatisfied, but physicians should take some time to explain why there is a negative effect with taking unnecessary antibiotics.
“The interaction and the time we take with patients are critical for engaging them as partners in their health care,” Septimus said. “If we take the time, we have better understanding and patients who are more satisfied.”
Septimus also said physicians must take individual accountability for their actions.
“One of the things that is missing in so many outpatient centers is accountability for our prescribing behaviors,” he said. “We need to change this — not just with education. Passive education doesn’t move the needle very far. We need an active, point-of-care clinical decision support function for physicians to remind us that, for many of these conditions, antibiotics are not indicated.”
For more information:
Barnett M. Abstract 962.
Barnett M. Abstract 963.
Both presented at ID Week 2013; Oct. 2-6, 2013; San Francisco.
Barnett M. JAMA Intern Med. 2013;doi:10.1001/jamainternmed.2013.11673.
Disclosure: Linder and Septimus report no relevant financial disclosures.