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Patterns of care before and after the adult sinusitis clinical practice guideline
Neil Bhattacharyya1, Lynn J Kepnes
1Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts, USA. neiloy@massmed.org
Objectives/Hypothesis:
Determine if patterns of care for acute sinusitis have changed after the publication of the adult sinusitis clinical practice guideline.
Study Design:
Cross-sectional study with historical controls.
Methods:
Cases of adult acute sinusitis occurring in 2005-2006 (before guideline publication) and 2009-2010 (>1 year after guideline publication) were extracted from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Care Survey. Changes in the rates of analgesic recommendations, oral antibiotic prescriptions, and choice of antibiotic therapy were determined and compared before and after guideline publication and relative to guideline recommendations.
Results:
An estimated 18.1 ± 1.8 million cases of adult acute sinusitis were studied before (7.9 ± 0.9 million visits for 2005-2006) and after (10.2 ± 1.5 million visits for 2009-2010) guideline publication. Recommendation rates for analgesics did not change significantly (18.9% before vs. 23.0% after, P=.470). The proportion of patients receiving oral antibiotics increased after guideline publication (75.5% before vs. 85.7% after, P=.021). In keeping with guideline recommendations, the proportion of patients treated with amoxicillin as the agent of choice when antibiotics are prescribed increased from 8.1% to 29.4% after guideline publication (P=.001).
Conclusions:
Care patterns for the medical treatment of acute adult sinusitis have changed after guideline publication, with an increase in oral antibiotic prescription rates in cases of acute sinusitis and increase in the use of amoxicillin as the first-line antimicrobial agent. The latter is strongly in keeping with guideline recommendation. Clinicians' espousal of the analgesic recommendations likely needs improvement to better comply with guideline recommendations.
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