Physicians with Kaiser Permanente in Pasadena Tackle Overprescription of Antibiotics

Reduced number through education and intervention

Published : Tuesday, November 21, 2017 | 6:13 PM

Physicians with Kaiser Permanente in Pasadena have reduced the odds of prescribing an antibiotic for sinusitis by 22 percent, using computer alerts to inform doctors when antibiotics may not be the best course of treatment.

A Kaiser Permanente press release said the study, published Tuesday in the American Journal of Managed Care, examined the effect of provider education and clinical decision support — specifically alerts on the electronic health record that physicians see during appointments — on antibiotic prescriptions for acute sinusitis, using a pragmatic stepped-wedge cluster randomized design.

During an eight-month period, from September 2014 through April 2015, the study tracked nearly 22,000 initial acute sinusitis encounters in adults at primary and urgent care offices, the press release said.

Dr. Adam Sharp, a researcher with the Kaiser Permanente Department of Research and Evaluation in Pasadena, said the work is a continuation of research to better understand what drives over-prescription of antibiotics and determine best approaches to improving physician prescribing practices.

Sharp also works as an emergency department physician at the Kaiser Permanente Los Angeles Medical Center.

In May 2016, the Centers for Disease Control and Prevention published new data that said at least 30 percent of antibiotics prescribed in the United States are unnecessary. Analyzing antibiotic use in doctors’ offices and emergency departments throughout the United States, CDC researchers found that most of these unnecessary antibiotics are prescribed for respiratory conditions caused by viruses — including common colds, viral sore throats, bronchitis, and sinus and ear infections, which do not respond to antibiotics.

Based on the study, the CDC said about 47 million excess prescriptions each year put patients at needless risk for allergic reactions or the sometimes deadly diarrhea, Clostridium difficile.

In 2015, the White House released The National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB), setting a goal of reducing inappropriate outpatient antibiotic use by at least half by 2020. This means that 15 percent of antibiotic prescriptions — or half of the 30 percent that are unnecessary — must be eliminated by 2020 to meet the CARB goal.

“We know that a tincture of time, not antibiotics, is generally the best treatment for infections more commonly caused by viruses rather than bacteria,” Dr. Sharp said.

He added their research builds on studies conducted by the CDC and the U.S. Department of Veterans Affairs. This study was funded internally by Kaiser Permanente Southern California.

Co-authors of the study include Research Scientist Dr. Ernest Shen; Dr. Michael H. Kanter, medical director of Quality and Clinical Analysis at the Southern California Permanente Medical Group; Dr. Laura J. Berman, at the Department of Regulatory Relations and Performance Assessment at Kaiser Permanente; and Dr. Michael K. Gould, of the Kaiser Permanente Department of Research and Evaluation, all in Pasadena.

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