scholarly journals Yale Observation Scale for Predicting Serious Illness in Japanese Primary Care Settings

2019 ◽  
Author(s):  
Yu Masuda ◽  
Taichiro Muto ◽  
Takaaki Kishino ◽  
Hirokazu Kurahashi ◽  
Yoshiro Kitagawa ◽  
...  
Keyword(s):  
Primary Care ◽  
Sensitivity And Specificity ◽  
Upper Respiratory Tract ◽  
Serious Illness ◽  
Primary Care Settings ◽  
Observation Scale ◽  
Common Diagnosis ◽  
Infectious Illness ◽  
Yale Observation Scale ◽  
Tract Infections

Abstract Objectives The Yale observation scale (YOS), also called the Acute Illness Observation Scale, was developed to help detect serious illness in febrile children. We conducted this study to evaluate the clinical utility of the YOS for predicting serious illness in Japanese primary care settings. Method We conducted a prospective observational study from June 2015 to January 2018. We enrolled patients younger than 10 years, who attended the primary care centre at the Aichi Medical University Hospital and who had recorded YOS scores. Serious illnesses included invasive bacterial infections and any conditions requiring artificial ventilation, surgical treatment, or cardiopulmonary resuscitation. We calculated point estimates for YOS sensitivity and specificity for predicting serious illness and hospitalisation. We evaluated the area under the receiver operating characteristic curve (AUC) by the Youden index. Results The 260 participants (227 outpatients and 33 inpatients) had a median age of 1.75 years (range, 0–10); 80 (30.8%) were younger than 1 year, 131 (50.4 %) between 1 and 3 years, 44 (16.9%) between 4 and 7 years, and 5 (1.9%) between 8 and 10 years. Infectious illness was the most common diagnosis (n = 211), followed by allergic disease (n = 11) and trauma (n = 10). Among the 211 patients with infectious illness, upper respiratory tract infections were the most common (n = 55). Fourteen patients among the 29 with YOS >10, and 19 among those with YOS ≤10 were hospitalised. We found 6 patients with serious illnesses: intussusception (n = 1; YOS, 22), encephalitis (n = 1; YOS, 16) and urinary tract infection (n = 4; YOSs, 18, 16, 8 and 6). The sensitivity and specificity of the YOS for predicting serious illness at a cut-off point of 10 were 0.67 and 0.90, respectively. The corresponding values for hospitalisation at that cut-off point were 0.42 and 0.93, respectively. The AUCs of the YOS for predicting serious illness and hospitalisation were 0. 82 (excellent) and 0.74 (acceptable). Conclusions We conclude that a YOS >10 may be useful to predict severe paediatric diseases in Japanese primary care settings.

scholarly journals Comparison of paracetamol and diclofenac prescribing preferences for adults in primary care

2021 ◽  
Vol 22 ◽  
Author(s):  
Dilara Bayram ◽  
Volkan Aydin ◽  
Abdullah Sanli ◽  
Mustafa Naci Abanoz ◽  
Busra Sibic ◽  
...  
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
Primary Care Physicians ◽  
Respiratory Tract Infections ◽  
Upper Respiratory Tract Infections ◽  
Upper Respiratory Tract ◽  
Analgesic Drugs ◽  
Common Diagnosis ◽  
Upper Respiratory ◽  
Tract Infections

Abstract Introduction: The most frequently prescribed analgesic drugs in primary care centers in Turkey are diclofenac and paracetamol, respectively. In this study, we aimed to compare paracetamol-included prescriptions (PIP) and diclofenac-included prescriptions (DIP) generated for adult patients in primary care. Methods: In this cross-sectional study, PIPs (n = 280 488) and DIPs (n = 337 935) created for adults by systematic sampling among primary care physicians working in Istanbul in 2016 (n = 1431) were examined. The demographic characteristics, diagnoses, and additional drugs in PIPs and DIPs were compared. Results: Women constituted the majority in both groups (69.8% and 67.9%, respectively; P < 0.05), and mean age at PIP (52.6 ± 18.8 years) was lower compared to DIP (56.3 ± 16.1 years), (P < 0.05). In single-diagnosis prescriptions, 11 of the 15 most common diagnoses in PIP were respiratory tract infections (47.9%); three pain-related diagnoses formed 4.6% of all these prescriptions. In DIP, the number of pain-related diagnoses, mostly of musculoskeletal origin, was eight (28.5%); four diagnoses (7.8%) were upper respiratory tract infections. While hypertension was the third most common diagnosis in PIP (6.1%), it was ranked first in DIP (8.0%). The percentage of prescriptions with additional analgesic (14.0% versus 18.3%, P < 0.001), proton-pump inhibitor (13.8% versus 18.4%; P < 0.001), and antihypertensive (22.0% versus 24.8%, P < 0.001) was lower in PIP compared to DIP. However, the percentage of prescriptions with antibiotics (31.3% versus 14.7%, P < 0.001) was higher in PIP. Conclusion: Paracetamol appears to be preferred mostly in upper respiratory tract infections compared to the preference of diclofenac rather in painful/inflammatory musculoskeletal conditions. The presence of hypertension among the most commonly encountered diagnoses for these analgesic drugs points to challenges in establishing the diagnosing-treatment match and indicates potential irrational prescribing practice, especially for interactions.

scholarly journals Inappropriate Azithromycin Use in Nine Primary-Care Clinics Before and After Implementation of Provider Guidance in the EMR

2020 ◽  
Vol 41 (S1) ◽  
pp. s292-s293
Author(s):  
Alexandria May ◽  
Allison Hester ◽  
Kristi Quairoli ◽  
Sheetal Kandiah
Keyword(s):  
Primary Care ◽  
Retrospective Chart Review ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
National Guidelines ◽  
Targeted Interventions ◽  
Primary Care Clinics ◽  
Before And After ◽  
Upper Respiratory ◽  
Tract Infections

Background: According to the CDC Core Elements of Outpatient Stewardship, the first step in optimizing outpatient antibiotic use the identification of high-priority conditions in which antibiotics are commonly used inappropriately. Azithromycin is a broad-spectrum antimicrobial commonly used inappropriately in clinical practice for nonspecific upper respiratory infections (URIs). In 2017, a medication use evaluation at Grady Health System (GHS) revealed that 81.4% of outpatient azithromycin prescriptions were inappropriate. In an attempt to optimize outpatient azithromycin prescribing at GHS, a tool was designed to direct the prescriber toward evidence-based therapy; it was implemented in the electronic medical record (EMR) in January 2019. Objective: We evaluated the effect of this tool on the rate of inappropriate azithromycin prescribing, with the goal of identifying where interventions to improve prescribing are most needed and to measure progress. Methods: This retrospective chart review of adult patients prescribed oral azithromycin was conducted in 9 primary care clinics at GHS between February 1, 2019, and April 30, 2019, to compare data with that already collected over a 6-month period in 2017 before implementation of the antibiotic prescribing guidance tool. The primary outcome of this study was the change in the rate of inappropriate azithromycin prescribing before and after guidance tool implementation. Appropriateness was based on GHS internal guidelines and national guidelines. Inappropriate prescriptions were classified as inappropriate indication, unnecessary prescription, excessive or insufficient treatment duration, and/or incorrect drug. Results: Of the 560 azithromycin prescriptions identified during the study period, 263 prescriptions were included in the analysis. Overall, 181 (68.8%) of azithromycin prescriptions were considered inappropriate, representing a 12.4% reduction in the primary composite outcome of inappropriate azithromycin prescriptions. Bronchitis and unspecified upper respiratory tract infections (URI) were the most common indications where azithromycin was considered inappropriate. Attending physicians prescribed more inappropriate azithromycin prescriptions (78.1%) than resident physicians (37.0%) or midlevel providers (37.0%). Also, 76% of azithromycin prescriptions from nonacademic clinics were considered inappropriate, compared with 46% from academic clinics. Conclusions: Implementation of a provider guidance tool in the EMR lead to a reduction in the percentage of inappropriate outpatient azithromycin prescriptions. Future targeted interventions and stewardship initiatives are needed to achieve the stewardship program’s goal of reducing inappropriate outpatient azithromycin prescriptions by 20% by 1 year after implementation.Funding: NoneDisclosures: None

scholarly journals Retrospective review of the management of acute infections and the indications for antibiotic prescription in primary care in northern Thailand

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e022250 ◽  
Author(s):  
Rachel C Greer ◽  
Daranee Intralawan ◽  
Mavuto Mukaka ◽  
Prapass Wannapinij ◽  
Nicholas P J Day ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Retrospective Review ◽  
Antibiotic Prescription ◽  
Multivariable Logistic Regression Analysis ◽  
Upper Respiratory Tract ◽  
Acute Tonsillitis ◽  
Northern Thailand ◽  
Acute Infections ◽  
Tract Infections

IntroductionAntibiotic use in low-income and middle-income countries continues to rise despite the knowledge that antibiotic overuse can lead to antimicrobial resistance. There is a paucity of detailed data on the use of antibiotics in primary care in low-resource settings.ObjectiveTo describe the presentation of acute infections and the indications for antibiotic prescription.DesignA 2-year retrospective review of routinely collected data.SettingAll 32 primary care units in one district in northern Thailand.ParticipantsPatients attending primary care with a history of fever, documented temperature, International Statistical Classification of Diseases 10 code for infection or prescribed a systemic antibiotic. Patients attending after the initiation of a study on C-reactive protein testing in four centres were excluded.Outcome measuresThe proportion of patients prescribed an antibiotic and the frequency of clinical presentations.Results762 868 patients attended the health centres, of whom 103 196 met the inclusion criteria, 5966 were excluded resulting in 97 230 attendances consisting of 83 661 illness episodes.46.9% (39 242) of the patients were prescribed an antibiotic during their illness. Indications for antibiotic prescription in the multivariable logistic regression analysis included male sex (adjusted OR (aOR) 1.21 (95% CI 1.16 to 1.28), p<0.001), adults (aOR 1.77 (95% CI 1.57 to 2), p<0.001) and a temperature >37.5°C (aOR 1.24 (95% CI 1.03 to 1.48), p=0.020). 77.9% of the presentations were for respiratory-related problems, of which 98.6% were upper respiratory tract infections. The leading infection diagnoses were common cold (50%), acute pharyngitis (18.9%) and acute tonsillitis (5%) which were prescribed antibiotics in 10.5%, 88.7% and 87.1% of cases, respectively. Amoxicillin was the most commonly prescribed antibiotic.ConclusionsNearly half of the patients received an antibiotic, the majority of whom had a respiratory infection. The results can be used to plan interventions to improve the rational use of antibiotics. Further studies in private facilities, pharmacies and dental clinics are required.

scholarly journals Antibiotic prescribing quality for children in primary care: an observational study

2018 ◽  
Vol 68 (667) ◽  
pp. e90-e96 ◽  
Author(s):  
Megan Rose Williams ◽  
Giles Greene ◽  
Gurudutt Naik ◽  
Kathryn Hughes ◽  
Christopher C Butler ◽  
...  
Keyword(s):  
Primary Care ◽  
Young Children ◽  
Otitis Media ◽  
Descriptive Analysis ◽  
Inappropriate Prescribing ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
Tract Infections ◽  
Disease Specific

BackgroundOveruse and inappropriate prescribing of antibiotics is driving antibiotic resistance. GPs often prescribe antibiotics for upper respiratory tract infections (URTIs) in young children despite their marginal beneficial effects.AimTo assess the quality of antibiotic prescribing for common infections in young children attending primary care and to investigate influencing factors.Design and settingAn observational, descriptive analysis, including children attending primary care sites in England and Wales.MethodThe Diagnosis of Urinary Tract infection in Young children study collected data on 7163 children aged <5 years, presenting to UK primary care with an acute illness (<28 days). Data were compared with the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) disease-specific quality indicators to assess prescribing for URTIs, tonsillitis, and otitis media, against ESAC-Net proposed standards. Non-parametric trend tests and χ2tests assessed trends and differences in prescribing by level of deprivation, site type, and demographics.ResultsPrescribing rates fell within the recommendations for URTIs but exceeded the recommended limits for tonsillitis and otitis media. The proportion of children receiving the recommended antibiotic was below standards for URTIs and tonsillitis, but within the recommended limits for otitis media. Prescribing rates increased as the level of deprivation decreased for all infections (P<0.05), and increased as the age of the child increased for URTIs and tonsillitis (P<0.05). There were no other significant trends or differences.ConclusionThe quality of antibiotic prescribing in this study was mixed and highlights the scope for future improvements. There is a need to assess further the quality of disease-specific antibiotic prescribing in UK primary care settings using data representative of routine clinical practice.

scholarly journals Treatment of Upper Respiratory Tract Infections in Primary Care: A Randomized Study Using Aromatic Herbs

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Eran Ben-Arye ◽  
Nativ Dudai ◽  
Anat Eini ◽  
Moshe Torem ◽  
Elad Schiff ◽  
...  
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
Essential Oils ◽  
Symptom Severity ◽  
Respiratory Tract Infections ◽  
Upper Respiratory Tract Infections ◽  
Study Group ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Tract Infections

This study is a prospective randomized double-blind controlled trial whose aim was to investigate the clinical effects of aromatic essential oils in patients with upper respiratory tract infections. The trial was conducted in six primary care clinics in northern Israel. A spray containing aromatic essential oils of five plants (Eucalyptus citriodora, Eucalyptus globulus, Mentha piperita, Origanum syriacum,andRosmarinus officinalis)as applied 5 times a day for 3 days and compared with a placebo spray. The main outcome measure was patient assessment of the change in severity of the most debilitating symptom (sore throat, hoarseness or cough). Sixty patients participated in the study (26 in the study group and 34 in the control group). Intention-to-treat analysis showed that 20 minutes following the spray use, participants in the study group reported a greater improvement in symptom severity compared to participants in the placebo group (). There was no difference in symptom severity between the two groups after 3 days of treatment (). In conclusion, spray application of five aromatic plants reported in this study brings about significant and immediate improvement in symptoms of upper respiratory ailment. This effect is not significant after 3 days of treatment.

scholarly journals Results from a Patient-Based Health Education Intervention in Reducing Antibiotic Use for Acute Upper Respiratory Tract Infections in the Private Sector Primary Care Setting in Singapore

2017 ◽  
Vol 61 (5) ◽  
Author(s):  
Magdalene Hui Min Lee ◽  
Darius Shaw Teng Pan ◽  
Joyce Huixin Huang ◽  
Mark I-Cheng Chen ◽  
Joash Wen Chen Chong ◽  
...  
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Care Setting ◽  
Primary Care Setting ◽  
Antibiotic Use ◽  
Upper Respiratory Tract Infections ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Tract Infections

ABSTRACT We investigated the efficacy of patient-targeted education in reducing antibiotic prescriptions for upper respiratory tract infections (URTIs) among adults in the private primary care setting in Singapore. Our randomized controlled trial enrolled patients aged 21 years and above presenting at general practitioner (GP) clinics with URTI symptoms for 7 days or less. Intervention arm patients were verbally educated via pamphlets about the etiology of URTIs, the role of antibiotics in treating URTIs, and the consequences of inappropriate antibiotic use. Control arm patients were educated on influenza vaccinations. Both arms were compared regarding the proportions prescribed antibiotics and the patients' postconsultation views. A total of 914 patients consulting 35 doctors from 24 clinics completed the study (457 in each arm). The demographics of patients in both arms were similar, and 19.1% were prescribed an antibiotic, but this varied from 0% to 70% for individual GPs. The intervention did not significantly reduce antibiotic prescriptions (odds ratio [OR], 1.20; 95% confidence interval [CI], 0.83–1.73) except in patients of Indian ethnicity (OR, 0.28; 95% CI, 0.09–0.93). Positive associations between the intervention and the view that antibiotics were not needed most of the time for URTIs (P = 0.047) and on being worried about the side effects of antibiotics (P = 0.018) were restricted to the Indian subgroup. GPs in limited liability partnerships or clinic chains prescribed less (OR, 0.36; 95% CI, 0.14 to 0.92), while certain inappropriate patient responses were associated with the receipt of antibiotics. Follow-up studies to investigate differences in responses to educational programs between ethnicities and to explore GP-targeted interventions are recommended.

scholarly journals Knowledge, Attitudes, and Reported Practices Among Obstetrician-Gynecologists in the USA Regarding Antibiotic Prescribing for Upper Respiratory Tract Infections

2005 ◽  
Vol 13 (1) ◽  
pp. 17-24 ◽  
Author(s):  
Shadi Chamany ◽  
Jay Schulkin ◽  
Charles E. Rose ◽  
Laura E. Riley ◽  
Richard E. Besser
Keyword(s):  
Primary Care ◽  
Respiratory Tract Infections ◽  
Antibiotic Use ◽  
Upper Respiratory Tract Infections ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
Office Visits ◽  
The Common ◽  
Upper Respiratory ◽  
Tract Infections

Background:Knowledge, attitudes, and practices regarding antibiotic prescribing for upper respiratory tract infections (URIs) have not been well described among obstetrician-gynecologists (OB/GYNs). This information is useful for determining whether an OB/GYN-specific program promoting appropriate antibiotic use would significantly contribute to the efforts to decrease inappropriate antibiotic use among primary care providers.Methods:An anonymous questionnaire asking about the treatment of URIs was sent to 1031 obstetrician-gynecologists.Results:The overall response rate was 46%. The majority of respondents (92%) were aware of the relationship between antibiotic use and antibiotic resistance, and respondents estimated that 5% of their patients had URI symptoms at their office visits. Overall, 56% of respondents reported that they would prescribe an antibiotic for uncomplicated bronchitis and 43% for the common cold. OB/GYNs with the fewest years of experience were less likely than those with the most years of experience to report prescribing for uncomplicated bronchitis (Odds ratio (OR) 0.46, 95% confidence interval (CI) 0.23 to 0.91) or the common cold (OR 0.44, CI 0.22 to 0.89). The majority of respondents (60%) believed that most patients wanted an antibiotic for URI symptoms, with male OB/GYNs being more likely than female OB/GYNs (OR 2.1, CI 1.2 to 3.8) to hold this belief. Both male OB/GYNs (OR 1.9, CI 1.1 to 3.4) and rural practitioners (OR 2.1, CI 1.1 to 4.0) were more likely to believe that it was hard to withhold antibiotics for URI symptoms because other physicians prescribe antibiotics for these symptoms. OB/GYNs who believed that postgraduate training prepared them well for primary care management were more likely than those who did not (OR 2.1, CI 1.1 to 4.2) to believe that they could reduce antibiotic prescribing without reducing patient satisfaction.Conclusion:Multiple demographic factors affect attitudes and reported practices regarding antibiotic prescribing. However, in view of the low proportion of office visits for URIs, an OB/GYN-specific program is not warranted.

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