Low-value care for acute sinusitis encounters: who's choosing wisely?

Area of Science:

• Medical research
• Clinical practice guidelines
• Healthcare quality improvement

Background:

• Acute sinusitis (AS) encounters are common in primary care (PC), urgent care (UC), and emergency departments (ED).
• Adherence to guidelines aimed at reducing low-value care, such as unnecessary antibiotic prescriptions and computed tomography (CT) scans, is critical.
• Understanding variations in care across different healthcare settings is essential for improving patient outcomes and resource allocation.

Purpose of the Study:

• To evaluate adherence to recommendations for avoiding low-value care in acute sinusitis (AS) encounters.
• To compare AS care across primary care (PC), urgent care (UC), and emergency department (ED) settings.
• To identify areas for improvement in antibiotic stewardship and imaging practices for AS.

Main Methods:

• Retrospective observational study of 152,774 adult AS encounters from 2010-2012 in a large integrated healthcare system.
• Comparison of antibiotic and CT scan utilization between ED/UC and PC encounters, with adjustments for patient characteristics.
• Analysis of antibiotic prescription appropriateness based on symptom duration and overall guideline adherence.

Main Results:

• Antibiotics were prescribed in 89.2% of AS encounters, and CT scans in 1.1%.
• ED encounters were less likely to receive antibiotics but more likely to involve CT scans compared to PC. UC encounters showed higher rates of both antibiotics and CT scans.
• Only 29% of encounters adhered to guidelines; 50% of antibiotic prescriptions were for symptoms lasting ≤7 days, while only 35% were for symptoms lasting ≥14 days.

Conclusions:

• While CT imaging for AS is infrequent, antibiotic use remains common across all care settings.
• Significant variations in AS care exist between PC, UC, and ED settings.
• Enhanced antibiotic stewardship is necessary in all settings to align with clinical recommendations and reduce low-value care.