234. Antibiotic Overprescribing for Acute Respiratory Illness in the Portland VA Outpatient Clinics
Session: Poster Abstract Session: Antimicrobial Stewardship in Clinical Practice
Friday, October 21, 2011
Room: Poster Hall B1
Background: A pilot study noted that antibiotics were prescribed to 35% of veterans for uncomplicated Acute Respiratory Infections (ARI).The present study characterizes non-adherence to antibiotic prescribing guidelines in this low risk population. All respiratory antibiotics are ordered via computer order entry (CPOE) in the electronic medical record, where indications with links to national guidelines are readily detailed. This expanded study adds statistical power along with additional provider type and clinic location detail.

Methods: A retrospective chart review was conducted from all Portland Veterans Administration Medical Center (PVAMC) outpatient clinics of subjects who presented between 7/08 and 6/09 with an ARI of 14 days duration or less. Exclusions included those who had chronic lung disease, major psychiatric illness, and those who had initially presented elsewhere, or who were following up for an ARI within 30 days of presentation. Independent variables abstracted included patient demographics, smoking status, diagnosis, clinical data, antibiotic use, ARI complications within 30 days post-encounter, provider type, and clinic location. The dependent variable of antibiotic overprescribing per guidelines, was the dichotomous outcome of interest.

Results: We identified 482 subjects with a mean age of 55, who were 87% male and 55% non-smokers. The visit diagnoses of either Sinusitis, Bronchitis, Pharyngitis, or Acute RTI were recorded in 94% of patients. Antibiotics were prescribed for 49% of subjects. When guidelines did not recommend antibiotics, they were given to 40% of patients (i.e. “overprescribed”). Wide variations in the risks determinants of overprescribing were noted, such as, diagnosis (ranging from Bronchitis; OR 6.0, p<0.0001, to Acute RTI; 0.3, p<0.0001) and clinic site (ranging from OR 0.5, p=0.0004, to OR 2.0, p=0.005). The corresponding risk factor of physician vs. non-physician was not significant (OR 1.2, p=0.400).

Conclusion: Veteran’s with ARI frequently receive antibiotics when not clinically indicated by guidelines. This study provides evidence of continued overprescribing despite CPOE directed guidelines. Further interventions are needed to optimize the use of antibiotics in this population.

Subject Category: J. Clinical practice issues

Ken Gleitsmann, MD1, Graeme Forrest, MBBS2, Linda Humphrey, MD MPH1, Donald Austin, MD MPH3 and Kennth James, PhD4, (1)Dept. of Medicine, Portland Veterans Administration Medical Center, Portland, OR, (2)Portland VA Medical Center, Portland, OR, (3)PHPM, Oregon Health & Science University, Portland, OR, (4)Biostatistics, Oregon Health & Science University, Portland, OR


K. Gleitsmann, None

G. Forrest, Cubist: Investigator, Research support
Astellas: Investigator, Research support

L. Humphrey, None

D. Austin, None

K. James, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.