Decrease antibiotic use for adults with acute bronchitis

The Physician Alliance is committed helping provide appropriate use of healthcare services and tests to improve patient care, while also working to lower costs. As part of BCBSM’s Resource Stewardship Initiative, our physician organization identified three key targets for reduction in utilization by our physicians based on current physician scores and TPA’s ranking among other physician organizations in these specific areas. TPA is currently ranked above the BCBSM’s Physician Group Incentive Program (PGIP) average for all physician organizations in these three areas (the goal is to be less than the PGIP average for these initiatives).

ABOUT THIS MEASURE:

Decreasing antibiotic use for acute bronchitis in adults (this is also a HEDIS metric) is a focus area for TPA. The PGIP average is 72 percent for antibiotic use for bronchitis in adults. TPA’s benchmark goal for this measure is 67 percent.

The most common reason adults are prescribed antibiotics is acute respiratory infection. Acute bronchitis is the most common diagnosis in these patients and accounts for more than 10 percent of ambulatory care visits in the United States. Viruses are responsible for more than 90 percent of acute bronchitis infections but 70 percent of these patients receive unnecessary prescription for antibiotics (according to the Journal of the American Medical Association).
Consider these facts:

  • Centers for Disease Control and Prevention reports that approximately 40 percent of patients receive antibiotics for unnecessary or inappropriate therapy, causing more than $3 billion spent on unnecessary health services.
  • Overuse of antibiotics can cause resistance to infections and unnecessary risks to patients. Antibiotic resistant bacteria cause at least 23,000 deaths each year in the U.S., according to the CDC.
  • The CDC and American College of Physicians state: “Clinicians should not perform testing or initiate antibiotic therapy in patients with bronchitis unless pneumonia is suspected.”

The following tips are recommended conversation strategies with patients experiencing symptoms of acute bronchitis:

  • Discuss symptom management with over-the-counter medications.
  • Define the acute bronchitis episode as a chest cold or viral infection.
  • Explain antibiotics do not reduce the duration of symptoms and may lead to adverse side effects.
  • Consider the “delayed” or wait and see prescription which instructs patients not to fill the prescription unless their symptoms do not improve over a certain time frame.

 HELPFUL RESOURCES:

TPA created flyer focused on decreasing antibiotic use that can be posted in waiting areas and exam rooms to help support conversations between physicians and patients.

 Choosing Wisely, an initiative of the ABIM Foundation, is a national healthcare campaign to promote important healthcare conversations between physicians and patients. Working with national medical societies, Choosing Wisely has produced numerous tip sheets focused on physician tips and patient tips.

 

Sources: Centers for Disease Control and Prevention, ChoosingWisely.org, American College of Physicians, American Academy of Family Physicians

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