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Antibiotic prescription for acute rhinosinusitis: Emergency departments versus primary care providers.
Laryngoscope. 2016 11; 126(11):2439-2444.L

Abstract

OBJECTIVES/HYPOTHESIS

We have previously identified patient characteristics associated with emergency department (ED) rather than primary-care provider (PCP) presentation for uncomplicated acute rhinosinusitis (ARS). Here we investigate potential disparities in prescription of antibiotics for patients presenting to a PCP versus ED for uncomplicated ARS.

STUDY DESIGN

Cross-sectional study of the 2005 to 2010 National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Surveys.

METHODS

A total of 37,975,715 patient presentations for uncomplicated ARS to PCPs and EDs. The primary outcome measure was prescription of an oral antibiotic, which was tested for association with clinical setting (PCP vs. ED) and clinical, demographic, and socioeconomic patient characteristics.

RESULTS

Among adult ARS presentations, 57.0% received an antibiotic prescription from a PCP versus 59.1% in the ED. Pediatric patients also were commonly prescribed antibiotics by PCPs (52.9%) and EDs (51.4%). Compared to PCPs, EDs were not associated with antibiotic prescription for adults (odds ratio [OR] = 1.09, 95% confidence interval [CI]: 0.79-1.50, P = 0.613) or children (OR = 0.94, 95% CI: 0.51-1.72, P = 0.840). Among PCP visits, antibiotic prescription was more likely in the Northeast United States (OR = 2.90, 95% CI: .31-6.38, P = 0.009). No other demographic, clinical, or socioeconomic patient characteristics, including insurance status, were associated with antibiotic prescription by PCPs or EDs.

CONCLUSION

More than half of ARS patients presenting to PCPs and EDs are prescribed antibiotics. There was no differential antibiotic prescription for ED versus PCP presentation. ARS patients in the Northeast were more likely to receive antibiotics from PCPs, whereas no such variation was seen for EDs. Interventions targeting PCPs, especially in the Northeast, may reduce excessive antibiotic utilization.

LEVEL OF EVIDENCE

4. Laryngoscope, 126:2439-2444, 2016.

Authors+Show Affiliations

Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A.. regan_bergmark@meei.harvard.edu.Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

27076067

Citation

Bergmark, Regan W., and Ahmad R. Sedaghat. "Antibiotic Prescription for Acute Rhinosinusitis: Emergency Departments Versus Primary Care Providers." The Laryngoscope, vol. 126, no. 11, 2016, pp. 2439-2444.
Bergmark RW, Sedaghat AR. Antibiotic prescription for acute rhinosinusitis: Emergency departments versus primary care providers. Laryngoscope. 2016;126(11):2439-2444.
Bergmark, R. W., & Sedaghat, A. R. (2016). Antibiotic prescription for acute rhinosinusitis: Emergency departments versus primary care providers. The Laryngoscope, 126(11), 2439-2444. https://doi.org/10.1002/lary.26001
Bergmark RW, Sedaghat AR. Antibiotic Prescription for Acute Rhinosinusitis: Emergency Departments Versus Primary Care Providers. Laryngoscope. 2016;126(11):2439-2444. PubMed PMID: 27076067.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antibiotic prescription for acute rhinosinusitis: Emergency departments versus primary care providers. AU - Bergmark,Regan W, AU - Sedaghat,Ahmad R, Y1 - 2016/04/14/ PY - 2016/01/11/received PY - 2016/02/18/revised PY - 2016/03/03/accepted PY - 2016/10/25/pubmed PY - 2017/7/28/medline PY - 2016/4/15/entrez KW - Antibiotics KW - ambulatory care sensitive condition KW - emergency service KW - healthcare delivery KW - healthcare disparities KW - hospital KW - insurance KW - primary care KW - sinusitis KW - socioeconomic factors SP - 2439 EP - 2444 JF - The Laryngoscope JO - Laryngoscope VL - 126 IS - 11 N2 - OBJECTIVES/HYPOTHESIS: We have previously identified patient characteristics associated with emergency department (ED) rather than primary-care provider (PCP) presentation for uncomplicated acute rhinosinusitis (ARS). Here we investigate potential disparities in prescription of antibiotics for patients presenting to a PCP versus ED for uncomplicated ARS. STUDY DESIGN: Cross-sectional study of the 2005 to 2010 National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Surveys. METHODS: A total of 37,975,715 patient presentations for uncomplicated ARS to PCPs and EDs. The primary outcome measure was prescription of an oral antibiotic, which was tested for association with clinical setting (PCP vs. ED) and clinical, demographic, and socioeconomic patient characteristics. RESULTS: Among adult ARS presentations, 57.0% received an antibiotic prescription from a PCP versus 59.1% in the ED. Pediatric patients also were commonly prescribed antibiotics by PCPs (52.9%) and EDs (51.4%). Compared to PCPs, EDs were not associated with antibiotic prescription for adults (odds ratio [OR] = 1.09, 95% confidence interval [CI]: 0.79-1.50, P = 0.613) or children (OR = 0.94, 95% CI: 0.51-1.72, P = 0.840). Among PCP visits, antibiotic prescription was more likely in the Northeast United States (OR = 2.90, 95% CI: .31-6.38, P = 0.009). No other demographic, clinical, or socioeconomic patient characteristics, including insurance status, were associated with antibiotic prescription by PCPs or EDs. CONCLUSION: More than half of ARS patients presenting to PCPs and EDs are prescribed antibiotics. There was no differential antibiotic prescription for ED versus PCP presentation. ARS patients in the Northeast were more likely to receive antibiotics from PCPs, whereas no such variation was seen for EDs. Interventions targeting PCPs, especially in the Northeast, may reduce excessive antibiotic utilization. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:2439-2444, 2016. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/27076067/Antibiotic_prescription_for_acute_rhinosinusitis:_Emergency_departments_versus_primary_care_providers_ L2 - https://doi.org/10.1002/lary.26001 DB - PRIME DP - Unbound Medicine ER -