Appropriately prescribing antibiotics for patients with pharyngitis: a physician-based approach vs a nurse-only triage and treatment algorithm

Duane K Undeland; Todd J Kowalski; Wendy L Berth; Jacob D Gundrum

doi:10.4065/mcp.2010.0382

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Appropriately prescribing antibiotics for patients with pharyngitis: a physician-based approach vs a nurse-only triage and treatment algorithm

Journal article

Open access

Peer reviewed

Appropriately prescribing antibiotics for patients with pharyngitis: a physician-based approach vs a nurse-only triage and treatment algorithm

Duane K Undeland, Todd J Kowalski, Wendy L Berth and Jacob D Gundrum

Mayo Clinic proceedings, Vol.85(11), pp.1011-1015

11/2010

DOI: 10.4065/mcp.2010.0382

PMCID: PMC2966364

PMID: 21037044

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Abstract

To assess the safety and appropriateness of antibiotic use in adult patients with pharyngitis who opted for a nurse-only triage and treatment algorithm vs patients who underwent a physician-directed clinical evaluation. Using International Classification of Diseases, Ninth Revision codes to query the electronic medical record database at our institution, a large multispecialty health care system in LaCrosse, WI, we identified adult patients diagnosed as having pharyngitis from September 1, 2005, through August 31, 2007. Diagnosis, treatment, and outcome data were collected retrospectively. Of 4996 patients who sought treatment for pharyngitis, 3570 (71.5%) saw a physician and 1426 (28.5%) opted for the nurse-only triage and treatment algorithm. Physicians adhered to antibiotic-prescribing guidelines in 3310 (92.7%) of 3570 first visits, whereas nurses using the algorithm adhered to guidelines in 1422 (99.7%) of 1426 first visits (P<.001). Physicians were significantly less likely to follow guidelines at patients' subsequent visits for a single pharyngitis illness than at their initial one (92.7% [3310/3570] vs 83.7% [406/485]; P<.001). Instituting a simple nurse-only triage and treatment algorithm for patients presenting with pharyngitis appears to reduce unnecessary antibiotic use.

Pharyngitis - microbiology

Triage - methods

Anti-Bacterial Agents - standards

Streptococcus pyogenes - drug effects

Practice Patterns, Nurses

Humans

Medical Records

Practice Patterns, Physicians

Drug Utilization Review

Algorithms

Guideline Adherence

Triage - standards

Pharyngitis - drug therapy

Adult

Streptococcal Infections - drug therapy

Anti-Bacterial Agents - adverse effects

Retrospective Studies

Anti-Bacterial Agents - administration & dosage

Wisconsin

Details

Title: Subtitle: Appropriately prescribing antibiotics for patients with pharyngitis: a physician-based approach vs a nurse-only triage and treatment algorithm
Creators: Duane K Undeland - Department of Medical Education, Gundersen Lutheran Health System, La Crosse, WI 54601, USA
Todd J Kowalski
Wendy L Berth
Jacob D Gundrum
Resource Type: Journal article
Publication Details: Mayo Clinic proceedings, Vol.85(11), pp.1011-1015
DOI: 10.4065/mcp.2010.0382
PMID: 21037044
PMCID: PMC2966364
ISSN: 0025-6196
eISSN: 1942-5546
Language: English
Date published: 11/2010
Academic Unit: General Internal Medicine; Internal Medicine
Record Identifier: 9984094715902771

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