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dc.contributor.authorWhaley, Lauren Een_US
dc.contributor.authorBusinger, Alexandra Cen_US
dc.contributor.authorDempsey, Patrick Pen_US
dc.contributor.authorLinder, Jeffrey Aen_US
dc.date.accessioned2014-03-10T16:17:05Z
dc.date.issued2013en_US
dc.identifier.citationWhaley, Lauren E, Alexandra C Businger, Patrick P Dempsey, and Jeffrey A Linder. 2013. “Visit complexity, diagnostic uncertainty, and antibiotic prescribing for acute cough in primary care: a retrospective study.” BMC Family Practice 14 (1): 120. doi:10.1186/1471-2296-14-120. http://dx.doi.org/10.1186/1471-2296-14-120.en
dc.identifier.issn1471-2296en
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:11877052
dc.description.abstractBackground: Guidelines and performance measures recommend avoiding antibiotics for acute cough/acute bronchitis and presume visits are straightforward with simple diagnostic decision-making. We evaluated clinician-assigned diagnoses, diagnostic uncertainty, and antibiotic prescribing for acute cough visits in primary care. Methods: We conducted a retrospective analysis of acute cough visits – cough lasting ≤21 days in adults 18–64 years old without chronic lung disease – in a primary care practice from March 2011 through June 2012. Results: Of 56,301 visits, 962 (2%) were for acute cough. Clinicians diagnosed patients with 1, 2, or ≥ 3 cough-related diagnoses in 54%, 35%, and 11% of visits, respectively. The most common principal diagnoses were upper respiratory infection (46%), sinusitis (10%), acute bronchitis (9%), and pneumonia (8%). Clinicians prescribed antibiotics in 22% of all visits: 65% of visits with antibiotic-appropriate diagnoses and 4% of visits with non-antibiotic-appropriate diagnoses. Clinicians expressed diagnostic uncertainty in 16% of all visits: 43% of visits with antibiotic-appropriate diagnoses and 5% of visits with non-antibiotic-appropriate diagnoses. Clinicians expressed uncertainty more often when prescribing antibiotics than when not prescribing antibiotics (30% vs. 12%; p < 0.001). As the number of visit diagnoses increased from 1 to 2 to ≥ 3, clinicians were more likely to express diagnostic uncertainty (5%, 25%, 40%, respectively; p < 0.001) and prescribe antibiotics (16%, 25%, 41%, respectively; p < 0.001). Conclusions: Acute cough may be more complex and have more diagnostic uncertainty than guidelines and performance measures presume. Efforts to reduce antibiotic prescribing for acute cough should address diagnostic complexity and uncertainty that clinicians face.en
dc.language.isoen_USen
dc.publisherBioMed Centralen
dc.relation.isversionofdoi:10.1186/1471-2296-14-120en
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3765925/pdf/en
dash.licenseLAAen_US
dc.subjectAntibacterial agents, Respiratory tract infections, Cough, Physicians, Primary careen
dc.subjectDecision makingen
dc.subjectDiagnosisen
dc.titleVisit complexity, diagnostic uncertainty, and antibiotic prescribing for acute cough in primary care: a retrospective studyen
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden
dc.relation.journalBMC Family Practiceen
dash.depositing.authorLinder, Jeffrey Aen_US
dc.date.available2014-03-10T16:17:05Z
dc.identifier.doi10.1186/1471-2296-14-120*
dash.contributor.affiliatedLinder, Jeffrey A


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