8/6/2012 - The over-use of antibiotics is a major public health concern, and a new study by NorthShore University HealthSystem (NorthShore) found that physicians often rely on imprecise information when deciding whether or not to prescribe antibiotics. The study, published in the August 7, 2012, issue of the Annals of Internal Medicine, also suggests that the increasing use of electronic health records (EHRs) by hospitals and health systems provides a goldmine of data that, when analyzed properly, can supply physicians more exact, real-time information as they make this important decision.
"The more we use antibiotics the more antibiotic resistance is going to occur. So the last thing we want to do is prescribe them to patients who don't need them," said senior study author Ari Robicsek, MD, Vice President of Clinical and Quality Informatics at NorthShore and an epidemiologist. "Informatics tools that are increasingly available out there could provide clinicians with locally relevant, up-to-date data on what's going on in their communities. And if they have access to that data in real time it will make a difference at the point of care."
Physicians, lacking a quick diagnostic tool to tell them whether a patient has a bacterial or viral respiratory infection – antibiotics are ineffective in treating the latter – often prescribe antibiotics "just in case," said Robicsek. "This is a trend that has been incredibly resistant to change."
The study found that physicians, in deciding whether to prescribe or not, were strongly influenced by epidemiologic context such as recent news reports and public health updates, as well as their recent experience seeing patients with symptoms similar to those indicating febrile respiratory illness (FRI).
Patients who presented with FRI during a pandemic influenza period in 2009 were significantly less likely to be treated with an antibiotic than if they presented with the same syndrome during a non-pandemic season, the study found. Specifically, of 69 physicians assessed, 66 were less likely to prescribe antibiotics during the pandemic period. In addition, the more patients a physician evaluated for FRI in the previous week, the less likely they were to prescribe antibiotics to their next patient.
Robicsek said physicians are using this epidemiologic context and their own personal experience to make assumptions about the prevalence of bacterial and viral infections. When the physicians see more FRI patients or hear about a surge in cases in the news media or from public health officials they assume influenza – a viral illness – is going around and are less likely to prescribe antibiotics.
Robicsek said this points to the glaring need for more precise and timely data that can be delivered to physicians at all times, helping them make more effective treatment decisions.
The growing use of electronic health records (EHRs) among hospitals and healthcare systems makes such data analysis possible, he said. For this study, Robicsek and colleagues, including lead author Courtney Hebert, MD, who's now at Ohio State University, looked at 28,301 unique patient encounters for FRI within the NorthShore system, which includes four hospitals – Evanston, Highland Park, Glenbrook and Skokie – and more than 75 outpatient clinics. NorthShore has a comprehensive EHR, which made this data analysis possible.
"With the expansion of EHR use, the goal of tracking syndromic activity is increasingly within reach," study authors wrote. Lacking access to such data means caregivers "must acquire contextual information through the keyhole of their personal experience, media coverage, and occasional public health updates. Under such circumstances, physicians are often operating unaware of local epidemiological information that could help them make optimal treatment decisions."
Robicsek and NorthShore are currently developing a tool called What's Going Around that will constantly analyze data on patient encounters in the system and assess trends related to, for example, a specific diagnosis or geographic area. Physicians will then have access to that data as they see patients and make treatment decisions.
"This is an exciting step forward that will put relevant data at physicians' fingertips at the point of care," Robicsek said. "And that should lead to a decrease in the inappropriate use of antibiotics and an overall advancement in patient care."