Physician vs nurse prescribing of antibiotics for pharyngitis

January 01, 0001

Physician vs nurse prescribing of antibiotics for pharyngitis

The aim of this study was to assess the safety and appropriateness of antibiotic use in adult patients with pharyngitis who opted for a nurse-only triage and treatment algorithm vs patients who underwent a physician-directed clinical evaluation. Using International Classification of Diseases, Ninth Revision codes to query the electronic medical record database at their institution, a large multispecialty health care system in LaCrosse, WI, the researchers identified identified adult patients diagnosed as having pharyngitis from September 1, 2005, through August 31, 2007. Diagnosis, treatment, and outcome data were collected retrospectively. Of 4996 patients who sought treatment for pharyngitis, 3570 (71.5%) saw a physician and 1426 (28.5%) opted for the nurse- only triage and treatment algorithm.

Physicians adhered to antibiotic-prescribing guidelines in 92.7% of 3570 first visits, whereas nurses using the algorithm adhered to guidelines in 1422 99.7% of 1426 first visits (significant). Physicians were significantly less likely to follow guidelines at patients' subsequent visits for a single pharyngitis illness than at their initial one (92.7% vs 83.7%).

The researchers concluded: "Instituting a simple nurse- only triage and treatment algorithm for patients presenting with pharyngitis appears to reduce unnecessary antibiotic use."

The patients appear to be self-triaged. Fewer or more scripts do not tell us about appropriateness of diagnosis (accuracy of evaluation or algorithm) or treatments, nor outcomes.

For the full abstract, click here.

Mayo Clinic Proceedings 85(11):1011-1015, November 2010 © 2010 Mayo Foundation for Medical Education and Research
Appropriately Prescribing Antibiotics for Patients With Pharyngitis: A Physician-Based Approach vs a Nurse-Only Triage and Treatment Algorithm. Duane K. Undeland, Todd J. Kowalski, Wendy L. Berth and Jacob D. Gundrum.

Category: R. Respiratory, Keywords: antibiotics, prescribing, pharyngitis, retrospective cohort study, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 12 November 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.