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Algorithmic approach to upper respiratory tract infections in primary care

Huseyin Balcioglu, Abdullah Culhaci, Kazim Tirpan, Soner Turan

Introduction: Despite the majority of these infections being viral, a high percentage are regarded as bacterial infection by physicians and treated unnecessarily with antibiotics. We aimed to compare changes in patient-physician behaviors and therapeutic approaches and costs with use of Upper Respiratory Tract Infections (URTI) algorithms in primary care.

Material and Methods: This study is a randomized, controlled clinical field study, which was performed with the participation of 34 volunteer family physicians that were, later, divided into 2 groups as algorithm group and control group, with respect to their family center. Both groups were asked to fill surveys that were designed specifically for each group. Differences in therapeutic approaches and treatment costs were compared for both algorithm using and not using physician’s groups. At the end of the study, participant physicians were asked to answer a 12-question survey to assess their therapeutic approach to URTI.

Results: A total of 460 patients were included to study. When antibiotic prescribing rates were compared between the groups, significantly fewer antibiotics were prescribed in the algorithm group. Modelling experiments for all cases revealed that group itself and presence of a sore throat, cough and fever were effective variables for antibiotic prescribing. Modelling was performed separately to determine how algorithm affects decision making. Prescription fees are significantly higher in the antibiotics using group.

Conclusion: Although there are guidelines in the primary care practice, this behavioural change after a single training suggests that more training are necessary and application of record-based algorithm systems is required.