Download April - RSI Health Awareness

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[Resource Stewardship]
Health Promotion and Disease Prevention
PGIP PCMH capability 9.8 Training
April 2016
Jackson Health Network
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Resource Stewardship Education Training
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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.