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JHN [Resource Stewardship] Health Promotion and Disease Prevention PGIP PCMH capability 9.8 Training April 2016 Jackson Health Network JHN Resource Stewardship Education Training Office Staff Sign In Name Signature Office Manager Signature: _________________________________ Date: _________ Jackson Health Network April, 2016 Use of Antibiotics for Viral Upper Respiratory Infections Antibiotics for viral upper respiratory infections are not recommended. Despite this, a large percentage of health care visits for acute bronchitis result in a prescription for antibiotics. The Argument against Antibiotic Use in Acute Bronchitis Studies suggest only marginal clinical improvement with antibiotics compared to risk of adverse events caused by use. Meta-analysis identified reduction in cough symptoms but no improvement in patient activity level or quality of life. HEDIS measures identified the ideal use of antibiotics for acute bronchitis as near 0% in 2005. An IMS Institute for Healthcare Informatics study identified an estimated 11 million avoidable antibiotic outpatient prescriptions are given annually for acute bronchitis. There is a direct correlation between frequency of antibiotic use and antibiotic resistant infections including C. difficile and fewer new classes of antibiotics to treat resistant infections. The Impact of Antibiotics on Acute Bronchitis Why Antibiotics are Prescribed for Acute Bronchitis even if not Evidence-Based When providers do not recommend antibiotics patients may be upset. We need to remember the many reasons people expect an antibiotic to provide a cure. Patients are insistent - they believe antibiotics were effective in the past and are necessary as the best treatment. The risk of antibiotic use is not a concern compared to expected short term relief. Providers don’t have needed time to educate patients about the potential benefit with a viral infection and the risk/harm of unnecessary use. Providers may want to fulfill patient wishes to improve patient satisfaction scores. Jackson Health Network April, 2016 Assessing Acute Respiratory Symptoms The potential to miss pneumonia in patients, particularly elderly patients, often drives providers to prescribe antibiotics. The following algorithm is provided to assist in identifying patients at higher probability of pneumonia. Derived from clinical practice guidelines endorsed by the AAFP, ACP-ASIM, CDC and IDSA. Jackson Health Network W hen you feel sick, you want to feel better fast. But antibiotics aren’t the answer for every illness. This brochure can help you know when antibiotics work – and when they won’t. For more information, talk to your healthcare provider or visit www.cdc.gov/getsmart. The Risk: Bacteria Become Resistant What’s the harm in taking antibiotics anytime? Using antibiotics when they are not needed causes some bacteria to become resistant to the antibiotic. These resistant bacteria are stronger and harder to kill. They can stay in your body and can cause severe illnesses that cannot be cured with antibiotics. A cure for resistant bacteria may require stronger treatment – and possibly a stay in the hospital. To avoid the threat of antibiotic-resistant infections, the Centers for Disease Control and Prevention (CDC) recommends that you avoid taking unnecessary antibiotics. Antibiotics Aren’t Always the Answer Most illnesses are caused by two kinds of germs: bacteria or viruses. Antibiotics can cure bacterial infections – not viral infections. Bacteria cause strep throat, some pneumonia and sinus infections. Antibiotics can work. Viruses cause the common cold, most coughs and the flu. Antibiotics don’t work. Using antibiotics for a virus: • Will NOT cure the infection • Will NOT help you feel better • Will NOT keep others from catching your illness Protect Yourself With the Best Care Y ou should not use antibiotics to treat the common cold or the flu. If antibiotics are prescribed for you to treat a bacterial infection – such as strep throat – be sure to take all of the medicine. Only using part of the prescription means that only part of the infection has been treated. Not finishing the medicine can cause resistant bacteria to develop. Talk to Your Healthcare Provider to Learn More ? Commonly Asked Questions: How Do I Know if I Have a Viral or Bacterial Infection? Ask your healthcare provider and follow his or her advice on what to do about your illness. Remember, colds are caused by viruses and should not be treated with antibiotics. Won’t an Antibiotic Help Me Feel Better Quicker so That I Can Get Back to Work When I Get a Cold or the Flu? No, antibiotics do nothing to help a viral illness. They will not help you feel better sooner. Ask your healthcare provider what other treatments are available to treat your symptoms. If Mucus from the Nose Changes from Clear to Yellow or Green — Does This Mean I Need an Antibiotic? No. Yellow or green mucus does not mean that you have a bacterial infection. It is normal for mucus to get thick and change color during a viral cold. GET SMART… •Antibiotics are strong medicines, but they don’t cure everything. •When not used correctly, antibiotics can actually be harmful to your health. •Antibiotics can cure most bacterial infections. Antibiotics cannot cure viral illnesses. •Antibiotics kill bacteria – not viruses. •When you are sick, antibiotics are not always the answer. USE ANTIBIOTICS WISELY Talk with your healthcare provider about the right medicines for your health. Cold or Flu. Antibiotics Don’t Work for You. For more information, see the Centers for Disease Control and Prevention website at: www.cdc.gov/getsmart or call 1-800-CDC-INFO April, 2016 Use of ECG in Screening for Risk of Coronary Artery Disease Event Annual ECG screening of adults during a physical was routine in the past. Current evidence questions the impact on care and outcomes of this simple test that may lead to unnecessary invasive testing and treatment. To assist you in identifying the evidence for care, the Jackson Health Network Evidence-Based Medicine Subcommittee reviewed current guidelines and literature. Following is information gathered on use of ECG screening for low risk, asymptomatic adults as a component of a routine physical examination. Low-Risk, Asymptomatic Adults The US Preventive Services Task Force (USPSTF) identified lack of evidence that ECG results will change classification of patient risk category over conventional risk factors in identification of disease, lead to treatment change, or impact clinical outcomes. Their recommendation is While there is no direct harm for routine ECG screening, there is potential harm in unnecessary treatment and invasive testing when not justified by clinical symptomology. Patients with Diabetes Mellitus The ADA recommends screening for cardiovascular risk factors annually in all patients with Diabetes Mellitus. Identification of risk factors – dyslipidemia, hypertension, smoking, family history of premature coronary disease and presence of albuminuria are the components of risk identified in the 2016 Standards of Care. Their recommendations are In asymptomatic patients, routine screening is not recommended as it does not improve outcomes (Grade A evidence). Patients at high ASCVD risk should be receiving intensive medical therapy without screening ECG. Talking to your Patient Jackson Health Network wants to assist you in talking to your patient about routine ECG screening. The American Academy of Family Practice Choosing Wisely campaign has created an educational sheet for patients to explain the risk and cost of testing and steps to know and reduce risk of heart disease. Best Practice Documentation from CMS If you believe a patient demonstrates symptoms warranting ECG evaluation beyond the lifetime screening ECG in the IPPE, the following information identifies the attributes CMS requires to be considered “valid”. A specific order for the diagnostic test Documentation in the medical record supporting the need for the diagnostic test A separate, signed, written, and retrievable report with an interpretation of the diagnostic test The order for the diagnostic test, triggered by an event The diagnostic test to help diagnose the presence or absence of an arrhythmia An electronic signature or some indication on the results for all tests An indication that the ordering provider reviewed the results (or the provider must indicate this in the note) Jackson Health Network ® EKGs and exercise stress tests When you need them—and when you don’t E KGs and stress tests are tests to find out if you are at risk for heart disease and heart attack. An EKG, or electrocardiogram, measures your heart’s activity. In an exercise stress test, you have an EKG while you walk or jog on a treadmill. You may need these tests if you have symptoms of heart disease, like chest pain. Or you may need them if you already have heart disease or you have a high risk for heart disease. These tests can help your doctor measure your chances of having a heart attack and decide how to treat the problem. But in other cases, you should think twice about having these tests. Here’s why: Usually, you do not need these tests if you do not have any symptoms. The the tests are not useful for people who do not have symptoms of heart disease, like chest pain. Yet, many people with no symptoms have an EKG as part of their routine checkups. symptoms of heart disease. Yet almost half had had an EKG in the last five years. And almost one out of ten had an exercise stress test. For example, in 2010, Consumer Reports did a survey of nearly 1,200 people between the ages of 40 and 60. These people had no history or There are better and less costly ways to prevent heart disease than EKGs and exercise stress tests. See the next page. These tests can lead to follow-up tests and treatments that you do not need. EKGs and exercise stress tests will not harm you. But the results can be unclear. This can lead to other tests and treatments that do have risks. For example, if the results of your EKG are unclear, your doctor may order a coronary angiography. This can expose you to as much radiation as 600 to 800 chest X-rays. Radiation has effects that can add up, so it is best to avoid it when you can. EKGs and exercise stress tests can also lead to unnecessary treatments. You may be given drugs you do not need. Or, you may have a procedure called angioplasty to force open the arteries in your heart. This can help some people, but for many, lifestyle changes and medicine are just as good. Angioplasty causes a heart attack in one to two out of every 100 patients. The tests can be a waste of money. An EKG costs about $50, and an exercise stress test costs about $200 to $300, according to HealthcareBlueBook.com. Why waste money on tests you do not need? And if they lead to more tests and treatments, it can cost thousands of dollars. When are EKGs and exercise stress tests needed? In some cases, it can be important to get these tests. You should probably have an EKG and an exercise stress test if you have symptoms of heart disease, such as chest pain, shortness of breath, an irregular heartbeat, or heavy heartbeats. You may also need the tests if you have a history of heart disease. And you may need these tests if you have diabetes or other risks, and you want to start exercising. This report is for you to use when talking with your health-care provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk. © 2012 Consumer Reports. Developed in cooperation with the American Academy of Family Physicians. To learn more about the sources used in this report and terms and conditions of use, visit ConsumerHealthChoices.org/about-us/. 04/2012 Advice from Consumer Reports How should you protect your heart? These steps can help protect your heart, whether you have heart disease or just want to prevent it. Know your risks. Talk to your doctor. Your risk of heart disease depends on many things, such as your age, sex, cholesterol, blood pressure, and if you smoke or have diabetes. Use our heart risk calculator at ConsumerReports.org/heartrisk. Lower your risks. The best ways to lower your risk of heart disease are to: • Avoid smoking. • Lose extra weight. • Exercise regularly— brisk walking helps. • Manage stress. • Limit salt. • Avoid foods that are high in cholesterol, saturated fat, and transfats. • Ask your doctor if you should take low-dose aspirin. Have your blood pressure, cholesterol, and blood sugar tested regularly. These tests are proven, low-cost ways to help measure your risk of having heart disease. • Blood pressure. You should be tested at least once a year by a doctor using a blood-pressure cuff. • Cholesterol. You should have a blood test for cholesterol at least every five years after age 34 (for men) and age 44 (for women). The test should be the kind where you fast first. • Blood sugar. You should have a blood test at least once every three to five years to measure your blood sugar (glucose). Too much glucose can harm your blood vessels. If your blood pressure, cholesterol, or blood sugar are too high, work with your doctor to lower them. Most people can lower cholesterol and blood pressure with lifestyle changes and medicine. This reduces the risk of heart attacks and strokes.