An initiative to improve adherence to evidence-based guidelines in the treatment of URIs, sinusitis, and pharyngitis

Figures & data

Table 1 Antibiotic prescribing guidelines

Diagnosis	Guidelines
Pharyngitis	Bisno, et al. Clinic Infect Dis 2002
Upper respiratory tract infection	Wong et al. Am Fam Physician 2006
Sinusitis	Rosenfeld, et al. Otolaryngol Head Neck Surg 2007

Fig. 1 Patient population.

Table 2 Survey results for practicing members

How many years has it been since you graduated from medical school?
Years	Total	Percentage
0–5	23	76.67
6–10	3	10
11–15	1	3.33
More than 15 years	3	10
For the diagnoses of pharyngitis, URI, and sinusitis, how well do you know believe that you know the treatment guidelines?
	Total	Percentage
Not at all	0	0
Mildly well	10	33.33
Moderately well	16	53.33
Very well	4	13.33
For the diagnoses of pharyngitis, URI, and sinusitis, how often do you believe you prescribe antibiotics in a guideline adherent manner?
	Total	Percentage
0–25% of the time	6	20.0
26–50% of the time	8	26.67
51–75% of the time	10	33.33
76–100% of the time	6	20.0
For each of the following factors that might influence your decision to prescribe antibiotics, please indicate the importance of each factor:
		Total	Percentage
Patient desires antibiotics	Not at all important	12	40.00
	Mildly important	14	46.67
	Moderately important	3	10.0
	Very important	1	3.33
Uncertainty in diagnosis	Not at all important	2	6.67
	Mildly important	13	43.33
	Moderately important	14	46.67
	Very important	1	3.33
Lack of knowledge guidelines	Not at all important	5	16.67
	Mildly important	11	36.67
	Moderately important	10	33.33
	Very important	4	13.33
Lack of clinical decision support tools	Not at all important	6	20.0
	Mildly important	16	53.33
	Moderately important	7	23.33
	Very important	1	3.33

Table 3 Guideline adherence rates

Guideline		2008–2012 (12)	2013	p
Sinusitis	No	130	14	0.086
Yes	93	19
Total	223	33
Compliance %	41.70	57.58
Pharyngitis	No	104	21	0.918
Yes	33	7
Total	147	28
Compliance %	24.09	25.00
URI	No	75	25	0.004
Yes	287	194
Total	362	219
Compliance %	79.28	88.58
Total cases	No	309	60	<0.001
Yes	413	220
Total	722	280
Compliance %	57.2	78.6

Fig. 2 Fishbone diagram for non-adherence with guidelines.

Bell D. Promoting appropriate antimicrobial drug use: Perspective from the Centers for Disease Control and Prevention. Clin Infect Dis. 2001; 33(Suppl 3): 245–50.

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