Improving acute respiratory infection care through nurse phone care and academic detailing of physicians.
BACKGROUND
To address unnecessary use of antibiotics for uncomplicated acute respiratory infection, we implemented a standardized care pathway composed of: (1) academic detailing of primary care providers, and (2) telephonic care from nurses.


METHODS
To evaluate the intervention, we performed a retrospective time series study and cost analysis at a primary care provider network in the Pacific Northwest with 118 providers at seven sites. The main outcomes were: (1) antibiotic rate, (2) provider visits avoided, and (3) cost savings from the payer and health care system perspectives. Data were collected for January 2, 2010 to November 30, 2013, with the interventions occurring on March 1, 2012.


RESULTS
There were 54,283 acute upper respiratory infection visits (34,678 [64%] female; average age, 52.1 years). After the intervention, nurse phone consultation involved 13.8% (3,289 of 23,769) of care episodes. The intervention was associated with a 16.5% absolute decrease in antibiotic rate (95% CI, -0.205 to -0.125; P < .001), after adjustment. Post intervention, 1983 of 23,769 (8.3%) episodes did not require any provider visit (1133 per year). Single institution cost savings to payers exceeded $175,000.


CONCLUSIONS
Implementation of nurse phone care and provider academic detailing was associated with lower inappropriate antibiotic usage and fewer unnecessary provider visits.
From the Center for Health Services Research (BLW, RSM, CCB), and the Department of Family Medicine (KP), Virginia Mason Medical Center, Seattle.
Kim
K
Pittenger
From the Center for Health Services Research (BLW, RSM, CCB), and the Department of Family Medicine (KP), Virginia Mason Medical Center, Seattle.
Barbara L
BL
Williams
From the Center for Health Services Research (BLW, RSM, CCB), and the Department of Family Medicine (KP), Virginia Mason Medical Center, Seattle.
Robert S
RS
Mecklenburg
From the Center for Health Services Research (BLW, RSM, CCB), and the Department of Family Medicine (KP), Virginia Mason Medical Center, Seattle. Craig.blackmore@vmmc.org.
C Craig
CC
Blackmore
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000451:nursing*; D012189:Retrospective Studies; D013689:Telephone / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures
D000900:Anti-Bacterial Agents
Antibiotics; Cost Control; Quality of Health Care; Respiratory Infections