597 - Low-value care services for outpatient acute respiratory tract infections in the United States

Poster Number: 597
Publication Number: 597.208

Daniel Shapiro, Boston Children's Hospital, Boston, MA, United States; Adam Hersh, University of Utah School of Medicine, Salt Lake City, UT, United States

Background: Low-value care for acute respiratory tract infections (ARTIs) involves not only antibiotic overuse, but also the use of other diagnostic tests and treatments that provide minimal benefit. The extent of overlap between the epidemiology of antibiotic overuse and overuse of non-antibiotic low-value services for ARTIs is not well characterized.

Objective: To identify the frequency of low-value services for ARTIs in outpatient visits in the United States and to compare patient-, clinician-, and system-level factors associated with antibiotic and non-antibiotic low-value interventions.

Design/Methods: We performed a cross-sectional analysis using the National Ambulatory Medical Care and National Hospital Ambulatory Care Surveys (2010-2018). The multistage probability sampling design of these annual surveys allows for extrapolation of nationally representative estimates for visits to offices and emergency departments. Low-value antibiotic prescriptions included systemic antibiotics for upper respiratory tract infections, bronchitis, bronchiolitis, otitis media with effusion, or otitis externa. Low-value non-antibiotic services included cough/cold medicines for upper respiratory tract infections and corticosteroids, bronchodilators, or chest x-rays for bronchiolitis. We estimated the proportion of eligible encounters with each low-value service and developed separate multivariable logistic regression models to determine factors associated with low-value antibiotic and non-antibiotic services.

Results: The 13,607 sampled visits for ARTIs represented 231 million (95% CI: 213-349 million) weighted visits. The proportion of eligible encounters with low-value services was 24.8% (95% CI: 22.5-27.4%) for antibiotics and 17.0% (95% CI: 15.1-19.1%) for non-antibiotic services. (Table 1) Non-antibiotic low-value services were more common in visits in which antibiotics were prescribed (20.0%, 95% CI: 16.4-24.3%) than when antibiotics were not prescribed (14.0, 95% CI 11.9-16.5%) (P = 0.006). In multivariable analysis, both low-value antibiotic and non-antibiotic services had greater odds of occurring for older children, in the South (vs. Midwest), in physicians’ offices (vs. emergency departments), and among family/internal medicine practitioners (vs. pediatricians). (Table 2)Conclusion(s): Both antibiotic and non-antibiotic low-value services were common for outpatient ARTIs and had several overlapping visit characteristics. Efforts to de-implement antibiotic and non-antibiotic overuse for ARTIs might share common targets and approaches.
Dan Shapiro CVCV Shapiro_11_19_2021_HMS.pdf
Table 2. Factors associated with low-value interventions for ARTIs in the United States, 2010-2018Two separate logistic regression models were performed, one with the outcome of low-value antibiotics (middle column) and the second with the outcome of low-value non-antibiotics (right column). Advanced care practitioners included nurse practitioners and physicians’ assistants.