Appropriately prescribing antibiotics for patients with pharyngitis: a physician-based approach vs a nurse-only triage and treatment algorithm.

Abstract

OBJECTIVE: To assess the safety and appropriateness of antibiotic use in adult patients with pharyngitis who opted for a nurse-only triage and treatment algorithm vs patients who underwent a physician-directed clinical evaluation. PATIENTS AND METHODS: Using International Classification of Diseases, Ninth Revision codes to query the electronic medical record database at our institution, a large multispecialty health care system in LaCrosse, WI, we identified adult patients diagnosed as having pharyngitis from September 1, 2005, through August 31, 2007. Diagnosis, treatment, and outcome data were collected retrospectively. RESULTS: Of 4996 patients who sought treatment for pharyngitis, 3570 (71.5%) saw a physician and 1426 (28.5%) opted for the nurse-only triage and treatment algorithm. Physicians adhered to antibiotic-prescribing guidelines in 3310 (92.7%) of 3570 first visits, whereas nurses using the algorithm adhered to guidelines in 1422 (99.7%) of 1426 first visits (P<.001). Physicians were significantly less likely to follow guidelines at patients' subsequent visits for a single pharyngitis illness than at their initial one (92.7% [3310/3570] vs 83.7% [406/485]; P<.001). CONCLUSION: Instituting a simple nurse-only triage and treatment algorithm for patients presenting with pharyngitis appears to reduce unnecessary antibiotic use.