{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T22:56:39Z","timestamp":1769554599945,"version":"3.49.0"},"reference-count":31,"publisher":"Cambridge University Press (CUP)","issue":"4","license":[{"start":{"date-parts":[[2019,4,11]],"date-time":"2019-04-11T00:00:00Z","timestamp":1554940800000},"content-version":"unspecified","delay-in-days":10,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X19000163_as1\"><jats:title>Background:<\/jats:title><jats:p>Antibiotics are overprescribed for acute respiratory tract infections (ARIs). Guidelines provide criteria to determine which patients should receive antibiotics. We assessed congruence between documentation of ARI diagnostic and treatment practices with guideline recommendations, treatment appropriateness, and outcomes.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X19000163_as2\"><jats:title>Methods:<\/jats:title><jats:p>A multicenter quality improvement evaluation was conducted in 28 Veterans Affairs facilities. We included visits for pharyngitis, rhinosinusitis, bronchitis, and upper respiratory tract infections (URI-NOS) that occurred during the 2015\u20132016 winter season. A manual record review identified complicated cases, which were excluded. Data were extracted for visits meeting criteria, followed by analysis of practice patterns, guideline congruence, and outcomes.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X19000163_as3\"><jats:title>Results:<\/jats:title><jats:p>Of 5,740 visits, 4,305 met our inclusion criteria: pharyngitis (n\u00a0=\u00a0558), rhinosinusitis (n\u00a0=\u00a0715), bronchitis (n\u00a0=\u00a01,155), URI-NOS (n\u00a0=\u00a01,475), or mixed diagnoses (&gt;1 ARI diagnosis) (n\u00a0=\u00a0402). Antibiotics were prescribed in 68% of visits: pharyngitis (69%), rhinosinusitis (89%), bronchitis (86%), URI-NOS (37%), and mixed diagnosis (86%). Streptococcal diagnostic testing was performed in 33% of pharyngitis visits; group A <jats:italic>Streptococcus<\/jats:italic> was identified in 3% of visits. Streptococcal tests were ordered less frequently for patients who received antibiotics (28%) than those who did not receive antibiotics 44%; <jats:italic>P<\/jats:italic> &lt; .01). Although 68% of visits for rhinosinusitis had documentation of symptoms, only 32% met diagnostic criteria for antibiotics. Overall, 39% of patients with uncomplicated ARIs received appropriate antibiotic management. The proportion of 30-day return visits for ARI care was similar for appropriate (11%) or inappropriate (10%) antibiotic management (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.22).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X19000163_as4\"><jats:title>Conclusions:<\/jats:title><jats:p>Antibiotics were prescribed in most uncomplicated ARI visits, indicating substantial overuse. Practice was frequently discordant with guideline diagnostic and treatment recommendations.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2019.16","type":"journal-article","created":{"date-parts":[[2019,4,11]],"date-time":"2019-04-11T10:01:51Z","timestamp":1554976911000},"page":"438-446","source":"Crossref","is-referenced-by-count":9,"title":["Evaluation of uncomplicated acute respiratory tract infection management in veterans: A national utilization review"],"prefix":"10.1017","volume":"40","author":[{"given":"Jefferson G.","family":"Bohan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4320-7223","authenticated-orcid":false,"given":"Karl","family":"Madaras-Kelly","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Pontefract","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Makoto","family":"Jones","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melinda M.","family":"Neuhauser","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Bidwell Goetz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muriel","family":"Burk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Cunningham","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"for the ARI Management Improvement Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2019,4,11]]},"reference":[{"key":"S0899823X19000163_ref24","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2017.59"},{"key":"S0899823X19000163_ref23","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2753.2010.01495.x"},{"key":"S0899823X19000163_ref22","doi-asserted-by":"publisher","DOI":"10.5694\/mja16.01042"},{"key":"S0899823X19000163_ref21","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.0243"},{"key":"S0899823X19000163_ref17","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X8100100304"},{"key":"S0899823X19000163_ref16","unstructured":"16. Veterans Health administration handbook. 1058.05: VHA operations activities that may constitute research. Department of Veterans Affairs website. https:\/\/www.va.gov\/vhapublications\/publications.cfm?pub=2&order=asc&orderby=pub_Number. Published 2011. Accessed January 21, 2019."},{"key":"S0899823X19000163_ref15","unstructured":"15. VA informatics and computing infrastructure. Corporate Data Warehouse (CDW Database). Health Services Research and Development website. https:\/\/www.hsrd.research.va.gov\/for_researchers\/vinci\/. Accessed January 21, 2019."},{"key":"S0899823X19000163_ref12","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.2648"},{"key":"S0899823X19000163_ref10","doi-asserted-by":"publisher","DOI":"10.7326\/M14-1933"},{"key":"S0899823X19000163_ref4","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis370"},{"key":"S0899823X19000163_ref3","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis629"},{"key":"S0899823X19000163_ref31","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1055\/s-0038-1626725","article-title":"Development and validation of a natural language processing tool to identify patients treated for pneumonia across VA emergency departments","volume":"9","author":"Jones","year":"2018","journal-title":"Appl Clin Inform"},{"key":"S0899823X19000163_ref20","doi-asserted-by":"crossref","unstructured":"20. Madaras-Kelly KJ , Hruza H , Pontefract B , et al. Trends in antibiotic prescribing for acute respiratory tract infections and implementation of a provider directed intervention within the Veterans Affairs healthcare system. Abstract #208. Program and abstracts of the IDWeek 2018, October 3\u20137, 2018; San Francisco, CA.","DOI":"10.1093\/ofid\/ofy210.221"},{"key":"S0899823X19000163_ref13","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix474"},{"key":"S0899823X19000163_ref5","doi-asserted-by":"publisher","DOI":"10.1177\/0194599815572097"},{"key":"S0899823X19000163_ref6","doi-asserted-by":"publisher","DOI":"10.1378\/chest.129.1_suppl.1S"},{"key":"S0899823X19000163_ref18","unstructured":"18. Healthcare Analysis and Information Group (HAIG). A field unit of the Office of Strategic Planning and Analysis within the Office of the ADUSH for Policy and Planning. 2016: Page 21. Department of Veterans Affairs website. https:\/\/www.va.gov\/oig\/pubs\/VAOIG-15-04247-111.pdf. Published 2016. Accessed January 21, 2019."},{"key":"S0899823X19000163_ref8","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2016.328"},{"key":"S0899823X19000163_ref14","unstructured":"14. Centers for Medicare Services 2016 ICD9\/ICD10 GEMS. Centers for Medicare Services website. https:\/\/www.cms.gov\/Medicare\/Coding\/ICD10\/2018-ICD-10-CM-and-GEMs.html. Accessed January 21, 2019."},{"key":"S0899823X19000163_ref29","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-017-2602-7"},{"key":"S0899823X19000163_ref11","unstructured":"11. Drug and therapeutics committees\u2014a practical guide. World Health Organization website. http:\/\/apps.who.int\/medicinedocs\/en\/d\/Js4882e\/8.5.html. Accessed January 21, 2019."},{"key":"S0899823X19000163_ref30","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.11152"},{"key":"S0899823X19000163_ref26","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0275"},{"key":"S0899823X19000163_ref9","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.rr6506a1"},{"key":"S0899823X19000163_ref1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.4151"},{"key":"S0899823X19000163_ref7","unstructured":"7. Adult treatment recommendations for outpatient acute respiratory infections. Center for Disease Control and Prevention website. https:\/\/www.cdc.gov\/antibiotic-use\/community\/for-hcp\/outpatient-hcp\/index.html. Accessed January 21, 2019."},{"key":"S0899823X19000163_ref19","unstructured":"19. The Health of America Report. Antibiotic prescription fill rates declining the United States 2017. BlueCross BlueShield website. www.bcbs.com\/the-health-of-america\/reports\/antibiotic-prescription-rates-declining-in-the-US. Published 2017. Accessed January 21, 2019."},{"key":"S0899823X19000163_ref25","doi-asserted-by":"publisher","DOI":"10.1001\/archfami.9.10.997"},{"key":"S0899823X19000163_ref28","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmv107"},{"key":"S0899823X19000163_ref2","doi-asserted-by":"publisher","DOI":"10.7326\/M15-1840"},{"key":"S0899823X19000163_ref27","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2018.05.014"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X19000163","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,4,11]],"date-time":"2019-04-11T20:29:14Z","timestamp":1555014554000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X19000163\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4]]},"references-count":31,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2019,4]]}},"alternative-id":["S0899823X19000163"],"URL":"https:\/\/doi.org\/10.1017\/ice.2019.16","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4]]}}}