Self-reported familiarity with acute respiratory infection guidelines and antibiotic prescribing in primary care

• Published in: International journal for quality in health care 2010-12, Vol.22 (6), p.469-475
• Main Authors: Linder, Jeffrey A., Schnipper, Jeffrey L., Tsurikova, Ruslana, Volk, Lynn A., Middleton, Blackford
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; anti-bacterial agents; Anti-Bacterial Agents - therapeutic use; Drug Utilization Review; Female; Guideline Adherence; Health Knowledge, Attitudes, Practice; Humans; Male; physicians’ practice patterns; Practice Guidelines as Topic; Practice Patterns, Physicians' - standards; Practice Patterns, Physicians' - statistics & numerical data; primary health care; Primary Health Care - methods; Primary Health Care - standards; respiratory tract infections; Respiratory Tract Infections - drug therapy; Self Report
• ISSN: 1353-4505; 1464-3677
• DOI: 10.1093/intqhc/mzq052

Objective Familiarity with guidelines is generally thought to be associated with guideline implementation, adherence and improved quality of care. We sought to determine if self-reported familiarity with acute respiratory infection (ARI) antibiotic treatment guidelines was associated with reduced or more appropriate antibiotic prescribing for ARIs in primary care. Design, Setting, Participants and Main Outcome Measures We surveyed primary care clinicians about their familiarity with ARI antibiotic treatment guidelines and linked responses to administrative diagnostic and prescribing data for non-pneumonia ARI visits. Results Sixty-five percent of clinicians responded to the survey question about guideline familiarity. There were 208 survey respondents who had ARI patient visits during the study period. Respondents reported being ‘not at all’ (7%), ‘somewhat’ (30%), ‘moderately’ (45%) or ‘extremely’ (18%) familiar with the guidelines. After dichotomizing responses, compared with clinicians who reported being less familiar with the guidelines, clinicians who reported being more familiar with the guidelines had higher rates of antibiotic prescribing for all ARIs combined (46% versus 38%; n = 11 164; P < 0.0001), for antibiotic-appropriate diagnoses (69% versus 59%; n = 3213; P < 0.0001) and for non-antibiotic appropriate diagnoses (38% versus 28%; n = 7951; P < 0.0001). After adjusting for potential confounders, self-reported guideline familiarity was an independent predictor of increased antibiotic prescribing (odds ratio, 1.36; 95% confidence interval, 1.25–1.48). Conclusions Self-reported familiarity with an ARI antibiotic treatment guideline was, seemingly paradoxically, associated with increased antibiotic prescribing. Self-reported familiarity with guidelines should not be assumed to be associated with consistent guideline adherence or higher quality of care.