ArticleJournal of community hospital internal medicine perspectives2014
An initiative to improve adherence to evidence-based guidelines in the treatment of URIs, sinusitis, and pharyngitis.
Article in Journal of community hospital internal medicine perspectives, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 22 citations in OpenAlex.
- Controlled trial of the impact of a BC adult mental health practice support program (AMHPSP) on primary health care professionals' management of depression.BMC family practice · 2018Trial
- Barriers to Protocol Adherence in Emergency Departments and Evidence-Based Strategies for Successful Implementation: A Scoping Review.Journal of clinical medicine · 2026Review
- Antibiotic Prescribing Practices for Upper Respiratory Tract Infections Among Primary Care Providers: A Descriptive Study.Open forum infectious diseases · 2022Article
- Article
- Developing and Testing a Local Expert-Based Reading Process for Use to Examine Discrepancies Between Guidelines and Current Clinical Practices.Frontiers in psychiatry · 2021Article
- Risk Factors for Unnecessary Antibiotic Prescribing for Acute Respiratory Tract Infections in Primary Care.Mayo Clinic proceedings. Innovations, quality & outcomes · 2020Article
- Improving pediatric emergency department physicians' adherence to clinical practice guidelines on the diagnosis and management of group A beta-hemolytic streptococcal pharyngitis-a cross-sectional study.International journal of emergency medicine · 2018Article
- Provider and Site-Level Determinants of Testosterone Prescribing in the Veterans Healthcare System.The Journal of clinical endocrinology and metabolism · 2017Article
- Barriers and Strategies in Guideline Implementation-A Scoping Review.Healthcare (Basel, Switzerland) · 2016Article
- Sinusitis Treatment Guideline Adherence in the E-Visit Setting: A Performance Improvement Project.Applied clinical informatics · 2016Article
- Improving antibiotic adherence in treatment of acute upper respiratory infections: a quality improvement process.Journal of community hospital internal medicine perspectives · 2015Article
- Editor's Notes.Journal of community hospital internal medicine perspectives · 2014Article
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundUpper respiratory infections, acute sinus infections, and sore throats are common symptoms that cause patients to seek medical care. Despite well-established treatment guidelines, studies indicate that antibiotics are prescribed far more frequently than appropriate, raising a multitude of clinical issues.
methodsThe primary goal of this study was to increase guideline adherence rates for acute sinusitis, pharyngitis, and upper respiratory tract infections (URIs). This study was the first Plan-Do-Study-Act (PDSA) cycle in a quality improvement program at an internal medicine resident faculty practice at a university-affiliated community hospital internal medicine residency program. To improve guideline adherence for respiratory infections, a package of small-scale interventions was implemented aimed at improving patient and provider education regarding viral and bacterial infections and the necessity for antibiotics. The data from this study was compared with a previously published study in this practice, which evaluated the adherence rates for the treatment guidelines before the changes, to determine effectiveness of the modifications. After the first PDSA cycle, providers were surveyed to determine barriers to adherence to antibiotic prescribing guidelines.
resultsAfter the interventions, antibiotic guideline adherence for URI improved from a rate of 79.28 to 88.58% with a p-value of 0.004. The increase of adherence rates for sinusitis and pharyngitis were 41.7-57.58% (p=0.086) and 24.0-25.0% (p=0.918), respectively. The overall change in guideline adherence for the three conditions increased from 57.2 to 78.6% with the implementations (p<0.001). In planning for future PDSA cycles, a fishbone diagram was constructed in order to identify all perceived facets of the problem of non-adherence to the treatment guidelines for URIs, sinusitis, and pharyngitis. From the fishbone diagram and the provider survey, several potential directions for future work are discussed.
conclusionsPassive interventions can result in small changes in antibiotic guideline adherence, but further PDSA cycles using more active methodologies are needed.
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