#12 Comparing Treatment of Pediatric Bronchiolitis and Upper Respiratory Infections in Primary, Tertiary, and Urgent Care Settings

Abstract

Abstract Background Pediatric bronchiolitis and upper respiratory infections (URI) are almost always of viral origin and thus managed without antibiotics. Inappropriate antibiotic use for such diagnoses can contribute to antimicrobial resistance. We assessed the appropriateness of pediatric bronchiolitis and URI treatment in primary, tertiary, and urgent care settings within a large private health system in Upstate New York and compared treatment appropriateness between the three settings. Method We conducted a retrospective, observational chart review of patient visits in pediatric primary, pediatric tertiary, and urgent care settings where there was a presumptive diagnosis of bronchiolitis or URI between January 1 and December 31, 2019 using ICD-10 diagnostic codes. We assessed patient treatment for each visit as “appropriate,” “possibly appropriate,” or “inappropriate” based on extracted chart data. We performed simple proportion calculations for each treatment category in each care setting, and then compared proportions for each treatment category between settings using chi-square and logistic regression models. Results Of the 450 patient visits reviewed in each care setting, 354 primary care, 375 tertiary care, and 442 urgent care visits met the inclusion criteria. Table 1 shows the proportion of appropriate, possibly appropriate, and inappropriate visits in the primary, tertiary, and urgent care settings. The tertiary care and urgent care settings had a statistically significant proportion of possibly appropriate or inappropriate encounters at 2.4% and 4.8% respectively. In comparing odds ratios for possibly appropriate or inappropriate treatment of pediatric bronchiolitis and URIs between care settings, urgent care setting treatments were 5.77 times more likely to be inappropriate or possibly appropriate than in pediatric primary care settings (95% CI [1.71, 19.5]). Differences in treatment between primary and tertiary care settings and tertiary and urgent care settings were not statistically significant. Conclusion In 2019, nearly all reviewed encounters in the pediatric primary, pediatric tertiary, and urgent care settings within a large private health system in Upstate New York adhered to clinical guidelines for bronchiolitis and URI treatment. However, the urgent care setting had a significantly greater odds of possibly appropriate or inappropriate treatment of these pediatric infections, highlighting an opportunity for further education and intervention to improve guideline adherence for bronchiolitis and URI management in that setting.