As little as 29% of Sinusitis Visits Adhere to General ENT Guidelines
We’ve known for some years that antibiotics don’t help most bronchitis cases and other respiratory problems, like sinusitis. In fact, taking antibiotics isn’t as effective for treating bacterial sinusitis as is widely believed. The American Academy of Otolaryngology—Head and Neck Surgery Foundation says antibiotics fare only slightly better than waiting for the infection to go away on its own. This scant improvement is most likely not worth taking antibiotics. Yet over-prescribing antibiotics persists—even when they don’t help and can even hurt — a study says.
A new study published last month in the American Journal of Managed Care reports that particularly with urgent care, primary care and emergency departments, clinicians seldom follow evidence-based care guidelines for the treatment of common sinusitis. The study criticizes several clinical practices such as over-prescribing antibiotics and over-ordering CT scans.
From the report, only 29 percent of adult acute sinusitis encounters followed accepted clinical guidelines for the prescription of antibiotics, according to the Kaiser Permanente study. And they found the ordering of CT scans more likely in emergency room visits, resulting in expensive imaging tests.
Sinusitis strikes nearly 31 million Americans per year, according to the American Academy of Family Physicians, costing around $3 billion because of tests and procedures, outpatient and emergency department visits, and medication. It is one of the most prescribed conditions for which antibiotics are used, but national clinical guidelines state that antibiotics should only be used when it lasts more than seven days.
Providers may be going against what is suggested by current guidelines, the researchers suggest, resulting in unacceptable standards of care. From the study, antibiotics were prescribed in 89.2 percent of the 152,774 EHR encounters. Nearly 50 percent of these encounters were with patients having symptoms for fewer than seven days.
Granted, each recorded visit entails a different set of symptoms with unique circumstances, especially for those presenting the most urgent and severe symptoms. But from the study, over 75% of the cases took place at the primary care providers’ offices. This number is much too high, considering that most patients were given antibiotics when they had only exhibited symptoms for less than 7 days. We understand the importance of immediate relief, but it’s the long-term harm that should be overriding our decisions.
Despite the frequency of acute sinusitis cases, treatment and prescription habits have not been closely monitored. “A clear understanding of current practices requires awareness of how acute sinusitis is treated in different acute care settings,” say the researchers, from Kaiser Permanente’s large, integrated Southern California system.
This study points to how we as healthcare providers need to better understand and coordinate acute care services in order to achieve the triple crown of health care: that is, improving the patient-care experience, the overall population’s health, and reducing healthcare costs.
The age-old problem of over-prescribing antibiotics may be partly due to the difficulty in differentiating bacterial sinusitis infections from the more common viral ones. To help clinicians identify patients who are likely to benefit from antibiotics for acute sinusitis, the most pragmatic and evidence-based approach is to focus on the patient’s length of symptoms.