Necessity of Office Visits for Acute Respiratory Infections in Primary Care

Abstract

Background: Acute respiratory infections (ARIs) are the most common symptomatic reason to seek ambulatory care in the United States, but many ARI visits may not be necessary. Methods: We identified ARI visits to 14 primary care practices between May 2011 and May 2012 and randomly selected 500 visits, 439 of which were new ARI visits. We separated non- visit-required information (e.g., history of present illness [HPI], past medical history, etc.) from information that required an office visit (e.g., physical exam, testing, etc.). Reviewing non-visit- required information, we identified the diagnosis and whether an office visit appeared necessary. Independently, we reviewed the visit-required information and determined if the visit changed management. Results: The 439 ARI patients had an average age of 45 years and symptoms for 8 days. Based on non-visit-required information, 72% (316/439) of visits did not appear to require an office visit. The most common diagnoses were non-specific upper respiratory infection (39%), sinusitis (24%), and bronchitis (22%). The HPI diagnosis was an exact match for clinicians’ diagnosis in 67% (213/316) of visits. After reviewing the visit-required information, management did not change for 87% (276/316) of visits. Conclusions: About 2/3 of primary care ARI visits are not necessary for appropriate management. Improved, accurate, reliable pre-visit triage and management could reduce the burden of ARI visits on primary care.