Impact of Choosing Wisely on Antibiotic Prescription and CT Scan Use for Uncomplicated Acute Rhinosinusitis (ARS)
Sunday, March 4, 2018
South Hall A2 (Convention Center)
Hardik Patel, MD, Wei Zhang, MS, Yong-fang Kuo, PhD, Gulshan Sharma, MD, MPH
RATIONALE: Earlier this decade, American Board of Internal Medicine Foundation along with Consumer Reports, launched the Choosing Wisely campaign with goal to encourage conversations between clinicians and patients to choose care that is evidence based, non-duplicative, free from harm and truly necessary. Multiple medical societies recommend against prescribing antibiotics and/or performing CT scans in uncomplicated acute rhinosinusitis. Purpose of this study was to evaluate trends in antibiotic prescription and CT scan order for uncomplicated acute rhinosinusitis before and after Choosing Wisely publication.

METHODS: This was retrospective cohort study of adult patients with initial episode of uncomplicated acute rhinosinusitis encounters using one of the nation’s large commercial insurance databases. Acute rhinosinusitis was identified by ICD-9 code 461.x. We selected patients with this diagnosis from 2009 to 2015 to evaluate antibiotic prescription and CT scan orders within 30 days of diagnosis.

RESULTS: We evaluated 933,434 patients 3 years pre-publication (January 2009 to December 2011) of Choosing Wisely and 645,093 patients 3 years post-publication (June 2012 to May 2015). In this cohort, 85.69%, 86.42% and 87.05% of patients received antibiotic prescription during each year respectively for the 3 years before publication and 87.8%, 87.84% and 87.81% during each year respectively for the 3 years after publication. On other hand, 1.69%, 1.46% and 1.33% of patients had CT scan order before publication and 1.2%, 1.17% and 1.13% patients had CT scan order after publication.

CONCLUSIONS: This study shows no impact on antibiotic prescription and modest decline in CT scan for uncomplicated acute rhinosinusitis after Choosing Wisely publication.