Variability in the diagnosis and treatment of group a streptococcal pharyngitis by primary care pediatricians

Journal Name: 
Infect.Control Hosp.Epidemiol.
Authors: 
Fierro,J.L.
Prasad,P.A.
Localio,A.R.
Grundmeier,R.W.
Wasserman,R.C.
Zaoutis,T.E.
Gerber,J.S.
Abstract: 
Objective. To compare practice patterns regarding the diagnosis and management of streptococcal pharyngitis across pediatric primary care practices. Design. Retrospective cohort study. Setting. All encounters to 25 pediatric primary care practices sharing an electronic health record. Methods. Streptococcal pharyngitis was defined by an International Classification of Diseases, Ninth Revision code for acute pharyngitis, positive laboratory test, antibiotic prescription, and absence of an alternative bacterial infection. Logistic regression models standardizing for patient-level characteristics were used to compare diagnosis, testing, and broad-spectrum antibiotic treatment for children with pharyngitis across practices. Fixed-effects models and likelihood ratio tests were conducted to analyze within-practice variation. Results. Of 399,793 acute encounters in 1 calendar year, there were 52,658 diagnoses of acute pharyngitis, including 12,445 diagnoses of streptococcal pharyngitis. After excluding encounters by patients with chronic conditions and standardizing for age, sex, insurance type, and race, there was significant variability across and within practices in the diagnosis and testing for streptococcal pharyngitis. Excluding patients with antibiotic allergies or prior antibiotic use, off-guideline antibiotic prescribing for confirmed group A streptococcal pharyngitis ranged from 1% to 33% across practices (P < .001). At the clinician level, 13 of 25 sites demonstrated significant within-practice variability in off-guideline antibiotic prescribing (P
10
2014
Volume: 
35 Suppl 3
Pages: 
S79-S85
Keywords: 
adherence, classification, clinical, Cohort Studies, data, Diagnosis, Disease, electronic, factors, Guidelines, Health, hospital, Infection, Insurance, International Classification of Diseases, intervention, Laboratories, laboratory, Methods, patient, Patients, Pennsylvania, Pharyngitis, Philadelphia, primary care, race, Record, regression, support