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Research ArticleOriginal Article

Why Are Antibiotics Prescribed for Patients With Acute Bronchitis? A Postintervention Analysis

William J. Hueston, Julia E. Hopper, Elizabeth N. Dacus and Arch G. Mainous
The Journal of the American Board of Family Practice November 2000, 13 (6) 398-402; DOI: https://doi.org/10.3122/15572625-13-6-398
William J. Hueston
From the Department of Family Medicine (WJH, JEH, END, AGM), Medical University of South Carolina, Charleston. Address reprint requests to William J. Hueston, MD, Department of Family Medicine, MUSC, 295 Calhoun St., PO Box 250192, Charleston, SC 29425. Ms. Dacus and Ms. Hopper participated in the Family Medicine Summer Student Externship Program in the Department of Family Medicine.
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Julia E. Hopper
From the Department of Family Medicine (WJH, JEH, END, AGM), Medical University of South Carolina, Charleston. Address reprint requests to William J. Hueston, MD, Department of Family Medicine, MUSC, 295 Calhoun St., PO Box 250192, Charleston, SC 29425. Ms. Dacus and Ms. Hopper participated in the Family Medicine Summer Student Externship Program in the Department of Family Medicine.
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Elizabeth N. Dacus
From the Department of Family Medicine (WJH, JEH, END, AGM), Medical University of South Carolina, Charleston. Address reprint requests to William J. Hueston, MD, Department of Family Medicine, MUSC, 295 Calhoun St., PO Box 250192, Charleston, SC 29425. Ms. Dacus and Ms. Hopper participated in the Family Medicine Summer Student Externship Program in the Department of Family Medicine.
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Arch G. Mainous III
From the Department of Family Medicine (WJH, JEH, END, AGM), Medical University of South Carolina, Charleston. Address reprint requests to William J. Hueston, MD, Department of Family Medicine, MUSC, 295 Calhoun St., PO Box 250192, Charleston, SC 29425. Ms. Dacus and Ms. Hopper participated in the Family Medicine Summer Student Externship Program in the Department of Family Medicine.
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Abstract

Background: Despite the findings in controlled trials that antibiotics provide limited benefit in the treatment of acute bronchitis, physicians frequently prescribe antibiotics for acute bronchitis. The aim of this study was to determine whether certain patient or provider characteristics could predict antibiotic use for acute bronchitis in a system where antibiotic use had already been substantially reduced through quality-improvement efforts.

Methods: A retrospective chart review was performed in an academic family medicine training center that had previously instituted a quality-improvement project to reduce antibiotic prescribing for acute bronchitis. Patients who had acute bronchitis diagnosed during an 18-month period and who had no other secondary diagnosis for respiratory distress or a condition that would justify antibiotics were selected from a computerized-record database and included in the study (n = 135). Charts were reviewed to document patient symptoms, physical findings, provider and patient characteristics, and treatment.

Results: Thirty-five (26%) patients received antibiotics for their acute bronchitis. Adults were more likely to receive antibiotics than children (34% vs 3%, P < .001). Analysis of 20 different symptoms and physical findings showed that symptoms and signs were poor predictors of antibiotic use. Likewise, no significant differences were found based on prescribing habits of individual providers or provider level of training.

Conclusion: In a setting where antibiotic use for acute bronchitis had been decreased through an ongoing quality-improvement effort, it did not appear that providers selectively used antibiotics for patients with certain symptoms or signs. Other factors, such as nonclinical cues, might drive antibiotic prescribing even after clinical variation is suppressed.

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The Journal of the American Board of Family     Practice: 13 (6)
The Journal of the American Board of Family Practice
Vol. 13, Issue 6
1 Nov 2000
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Why Are Antibiotics Prescribed for Patients With Acute Bronchitis? A Postintervention Analysis
William J. Hueston, Julia E. Hopper, Elizabeth N. Dacus, Arch G. Mainous
The Journal of the American Board of Family Practice Nov 2000, 13 (6) 398-402; DOI: 10.3122/15572625-13-6-398

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Why Are Antibiotics Prescribed for Patients With Acute Bronchitis? A Postintervention Analysis
William J. Hueston, Julia E. Hopper, Elizabeth N. Dacus, Arch G. Mainous
The Journal of the American Board of Family Practice Nov 2000, 13 (6) 398-402; DOI: 10.3122/15572625-13-6-398
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