The American Academy of Allergy, Asthma, and Immunology has a lovely Choosing Wisely statement on sinusitis, featuring the following highlights:
- Antibiotics usually do not help sinus problems.
- Antibiotics cost money.
- Antibiotics have risks.
So, how does one of the United States largest organized health systems fare for the treatment of such a simple, basic, commonplace condition? A system, perhaps, that prides itself on internal quality initiatives and guideline adherence? Well, based on this sample of 152,774 Primary Care, Urgent Care, and Emergency Department patients in Kaiser Southern California, they are: still awful.
- ED patients received antibiotics 72.8% of the time.
- UC patients received antibiotics 89.3% of the time.
- PC patients received antibiotics 89.8% of the time.
And, not only that, antibiotic usage was all over the map, with large cohorts receiving prescriptions for less-appropriate options such as azithromycin and trimethoprim-sulfamethoxazole.
Why are we so terrible at this?
“Low-Value Care for Acute Sinusitis Encounters: Who’s Choosing Wisely?”