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Does Drug Treatment of Patients With Acute Bronchitis Reduce Additional Care Seeking?
Evidence From the Practice Partner Research Network
William J. Hueston, MD;
Ruth Jenkins, MS;
Arch G. Mainous, III, PhD
Arch Fam Med. 2000;9:997-1001.
Background Considerable discussion has focused on treatment methods for patients with acute bronchitis.
Objective To examine whether antibiotic or bronchodilator treatment is associated with differences in follow-up visit rates for patients with acute bronchitis.
Methods A retrospective medical chart review was conducted for patients with a new episode of acute bronchitis over a 3-year period in the Practice Partner Research Network (29 248 episodes in 24 753 patients). Primary outcomes of interest were another visit in the next 14 days (early follow-up) or 15 to 28 days after initial treatment (late follow-up).
Results Antibiotics were used more commonly in younger patients (<18 years), whereas older patients (>65 years) were more likely to receive no treatment. Younger patients treated with antibiotics were less likely to return for an early follow-up visit, but no differences were seen in adults and older patients. Late follow-up rates were not affected by the initial treatment strategy. When patients did return for a follow-up visit, no new medication was prescribed to most (66% of younger patients and 78% of older adults). However, compared with patients who did not receive an antibiotic at their first visit, patients initially treated with an antibiotic were about 50% more likely to receive a new antibiotic at their second visit.
Conclusions Initial prescribing of an antibiotic reduces early follow-up for acute bronchitis in younger patients but seems to have no effect in adults. However, reductions in future follow-up visits might be outweighed by increases in antibiotic consumption because patients who return for a follow-up visit seem to receive additional antibiotic prescriptions.
From the Department of Family Medicine and the Center for Health Care Research, Medical University of South Carolina, Charleston.
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