Laura E. Norton
Researchers found low adherence to Infectious Diseases Society of America clinical practice guidelines for group A streptococcal pharyngitis among physicians in a pediatric ambulatory setting. A quality improvement initiative, which included education for providers, patients and families on testing and antibiotic use for the condition, improved unnecessary testing.
"The idea for this project was initially prompted by a review of pilot data from the Children's Mercy Hospital ED that showed the majority of streptococcal pharyngitis testing in that setting was not indicated based on presenting signs and symptoms,” Laura E. Norton, MD, MS, a pediatric infectious disease physician at the University of Minnesota Medical School, told Infectious Diseases in Children. “Providers in the practice reported parental expectation for testing as one of the drivers for testing."
To reduce unnecessary testing and improve compliance to the IDSA guidelines for group A streptococcal (GAS) pharyngitis in a large community pediatrics practice, Norton and colleagues tested an American Board of Pediatrics-approved quality improvement project in Plan-Do-Study-Act cycles. This project included several strategies to address overtesting, which included educating providers on the IDSA guidelines, modifying office procedures, improving communication strategies and educating patients and families.
After implementing the quality improvement initiative, unnecessary GAS testing decreased from 64% to 40.5%. The presence of viral symptoms was the most common reason for unneeded testing.
Although the intervention reduced unnecessary testing significantly, the researchers did not observe a significant difference in appropriate antibiotic use for the condition. Norton and colleagues noted that most inappropriate antibiotic prescriptions were given when unnecessary testing was performed.
Based on reports from all physicians participating in the quality improvement intervention (n = 16), most believed that their communication about GAS pharyngitis testing and antibiotic use improved. This intervention, according to 94% of physicians who participated, did not decrease the efficiency of the clinic.
“For pediatricians who are looking to reduce rates of unnecessary testing, I recommend examining your current office procedures around the assessment of children presenting with a complaint of sore throat," Norton said. “Standing orders for testing of every child presenting to the clinic with a sore throat may result in unnecessary testing that is inconsistent with guideline recommendations.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.