Necessity of office visits for acute respiratory infections in primary care

Sruthi Renati, Jeffrey A. Linder*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

Background: Acute respiratory infections (ARIs) are the most common symptomatic reason to seek ambulatory care, but many ARI visits may not be necessary. Objective: To measure the proportion of primary care ARI visits that may not require an office visit. Methods: We identified 58398 ARI visits to 14 primary care practices between May 2011 and May 2012 and randomly selected 500 visits, 439 of which were new ARI visits. We separated non-visit-required information [e.g. history of present illness (HPI), past medical history, etc.] from information that required an office visit (e.g. physical exam, testing, etc.). Reviewing non-visit-required information, we identified the diagnosis (HPI diagnosis) and whether office visit appeared necessary. Independently, we reviewed the visit-required information and determined if the visit changed antibiotic management. Results: Based on non-visit-required information, 72% (316/439) of visits did not appear to require an office visit. The most common diagnoses were non-specific upper respiratory infection (39%), sinusitis (24%) and acute bronchitis (22%). The HPI diagnosis was an exact match for clinicians' diagnosis in 67% (213/316) of visits. After reviewing the visit-required information, antibiotic management did not change for 87% (276/316) of visits. For the remaining 13% (40/316) for which the visit changed management, the clinician prescribed an antibiotic for an antibiotic-appropriate diagnosis (65%; 26/40); prescribed an antibiotic for a non-antibiotic-appropriate diagnosis (25%; 10/40); or avoided an antibiotic prescription for patients with an HPI diagnosis of sinusitis (10%; 4/40). Conclusion: About two-thirds of primary care ARI visits may not be necessary for appropriate antibiotic management.

Original languageEnglish (US)
Pages (from-to)312-317
Number of pages6
JournalFamily practice
Volume33
Issue number3
DOIs
StatePublished - Jun 1 2016

Keywords

  • Antibacterial agents
  • Clinical decision-making
  • Health care costs
  • Patient acceptance of health care
  • Primary health care
  • Respiratory tract infections

ASJC Scopus subject areas

  • Family Practice

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