Performance measures requiring antibiotics for pneumonia have not boosted antibiotic use in nonpneumonia patients

Outcomes and Effectiveness Research
Performance measures requiring antibiotics for pneumonia have not boosted antibiotic use in nonpneumonia patients

In 2002, national performance measures were established for the treatment of pneumonia, including the requirement that patients receive antibiotics within 4 hours of hospital arrival. Since then, there has been concern that emergency departments (EDs) have increased their prescribing of antibiotics to patients who do not have pneumonia. Recent findings, however, suggest that such concerns may be unfounded.

Researchers looked at patients presenting with symptoms of pneumonia during 4 winter seasons (November through February) at 13 EDs affiliated with academic medical centers. Fifty visits were randomly selected for each month, for a total of 200 visits sampled per hospital per year for 2 years to identify trends in antibiotic prescribing. The data were collected as part of the Improving Antibiotic Use in Acute Care Treatment Trial. As part of this trial, eight of the hospital EDs received both patient and physician educational interventions on how to reduce the overuse of antibiotics.

A total of 6,476 patient visits were analyzed. All patients arrived at the ED with a cough and were discharged with a diagnosis of nonpneumonia acute respiratory infection. Antibiotics were prescribed in 6.1 percent of these visits. When adjustments were made for factors such as patient demographics and ED length of stay, no increase was observed in the administration of antibiotics. There was a statistically significant decrease in antibiotic use in EDs located at hospitals with educational interventions aimed at reducing inappropriate antibiotic use for colds, upper respiratory tract infections, and bronchitis during the winter months. The study was supported in part by the Agency for Healthcare Research and Quality (HS13915).

See "ED antibiotic use for acute respiratory illnesses since pneumonia performance measure inception," by Christopher Fee, M.D., Joshua P. Metlay, M.D., Ph.D., Carlos A. Camargo, Jr., M.D., Dr.P.H., and others in the 2010 American Journal of Emergency Medicine 28, pp. 23-31.
http://www.ahrq.gov/research/jul10/0710RA13.htm