Effectiveness of clinical pathway for upper respiratory tract infections in emergency department

Objective Despite the paucity of supporting evidence, the use of antibiotics in the management of upper respiratory tract infections (URTI) remains a persistent and worrying trend worldwide. This survey study set out to examine the antibiotic prescribing profile of emergency physicians for patients diagnosed with URTI at a local tertiary hospital. Methods Patients seeking treatment for URTI at the emergency department in the year 2001 were identified by their ICD-9 code. The electronic medical records of a random sample of these patients were reviewed. Patients with the following documented findings were excluded: (a) a duration of more than 7 days between disease onset and date of consultation, (b) prior antibiotic usage or medical consultation, (c) presentation of purulent sputum and/or purulent nasal discharge, and (d) existing medical conditions requiring antibiotic treatment/prophylaxis. Chi-square and multivariate analyses were performed to assess the association of patient-related factors with antibiotic prescribing. Results Of a random sample of 488 cases of URTI, inappropriate antibiotic prescribing was observed in 24% of cases (95% CI 20%, 28%). Significant associations were observed between antibiotic prescribing and month of consultation, patients' temperature and symptom of rhinorrhoea. Conclusion A substantial proportion of emergency department patients with URTI received antibiotics despite the lack of evidence supporting the drugs' effectiveness. Appropriate interventions to promote evidence-based prescribing amongst emergency physicians are required to reduce the extent of inappropriate antibiotic prescribing as well as to ensure the longevity of antibiotic effectiveness.

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Are Patient Decision Aids Effective in Decreasing Antibiotic Prescription for Acute Upper Respiratory Tract Infections During General Practice and Emergency Department Encounters: A Systematic Review Protocol (Preprint)

10.2196/preprints.11020 ◽

2018 ◽

Author(s):

Shiva Ramasamy ◽

Ali Gilani ◽

Mohamad Alshurafa ◽

Leesa Phillip ◽

Janath De Silva

Keyword(s):

Emergency Department ◽

Respiratory Tract ◽

Respiratory Tract Infections ◽

Antibiotic Prescription ◽

Decision Aids ◽

Upper Respiratory Tract Infections ◽

Upper Respiratory Tract ◽

Patient Decision ◽

Upper Respiratory ◽

Tract Infections

UNSTRUCTURED ABSTRACT Background Antibiotic resistance is a global issue that has a significant impact on patient morbidity and mortality. Evidence exists within the general practice and the emergency department setting to suggest that antimicrobial overuse is a significant contributor to resistance. Upper respiratory tract infections are a group of conditions for which antibiotics may be inappropriately prescribed. Patient decision aids are tools allowing for shared decision making between clinician and patient, incorporating patient values and the latest evidence into the decision of whether to prescribe antibiotics or not. Objectives To determine if patient decision aids are effective in decreasing antibiotic prescription for acute upper respiratory tract infections during general practice and emergency department encounters, and to comment on the depth of literature available in this field. Methods and Analysis We have established a protocol for a systematic review to assess the efficacy of patient decision aids in reducing antibiotic prescription for upper respiratory tract infections in general practices and emergency departments. A set of inclusion criteria has been established. We will include systematic reviews and randomised controlled trials only. A search strategy was formed and will be used in the Medline, Embase, ScienceDirect and Cochrane databases as well as sources of unpublished literature. Primary and secondary outcomes will focus on immediate and longer-term antibiotic prescription rate and patient decision aid efficacy. We have established a literature screening process and criteria for quantitative synthesis. Literature screening and study quality assessment will be carried out by two independent and blinded reviewers. We will use a single data extraction protocol. Results We are yet to start any formal data collection or analysis but have secured funding from Mackay Institute of Research and Innovation. Ethics and Dissemination It was decided that this systematic review protocol did not require ethical approval. Study sponsors will be communicated with regularly regarding the study, which will be published in a journal in the relevant field. Any updates to the protocol will be published as required. Registration Prospero registration number: CRD42017069598 Keywords Patient decision aid; Shared decision making; Upper respiratory tract infection; Antibiotic prescription; General practice; Emergency department

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