Choosing Wisely
Integrating Choosing Wisely into existing health and wellness initiatives OSU Health Plan Susan Meyer, PhD., Director of Marketing/Communications
Integrating Choosing Wisely into primary care quality improvement St. Ann’s Family Medicine Center Philip Berger, MD Thomas Cowan, MD Ruheena Sadi, MD Colin Turney, MD Lyndsey Vance, RN
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Sinusitis: New Optimal Treatment – The SNOT Study Colin Turney, MD Ruheena Sadi, MD Thomas Cowan, MD Lyndsey Vance, RN Philip Berger, MD
St. Ann’s Family Medicine Center • Mount Carmel Family Medicine Residency • 18 Residents, 6 Faculty, 1 Behaviorist, 1 Pharmacist, 1 Social Worker, 5 Registered Nurses, 2 Medical Assistants • 12,000 primary care visits annually • Dedicated to learning patient care as well as research and quality improvement in both inpatient and outpatient settings 3
Plan • Use of antibiotics in treating sinusitis.
• Nationally, Antibiotics prescribed for 80% of office visits for sinusitis. Total annual cost is $5.8 billion1. • Antibiotics can cause side effects, including GI upset, dizziness, and rash. Overuse of antibiotics breeds future antibiotic resistance. • Antibiotics are appropriate if the patient has a fever of 101.5 or higher, severe pain around the sinuses, a concurrent skin infection, worsening symptoms after initial improvement, or symptoms that have lasted for seven days or longer.
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Information taken from www.choosingwisely.org
Do • Education on the appropriate use of antibiotics provided to all nurses, resident physicians, and faculty physicians. • Appropriate use of antibiotics has been discussed and reviewed weekly at both the physician and nursing level. • Educational materials have been placed alongside each physician’s daily office schedule. • A poster summarizing the recommendations of the choosing wisely campaign has been placed in each patient exam room. • EHR (NextGen) documentation reviewed to monitor the percentage of encounters which are appropriately using antibiotics for sinusitis.
Study • We are collecting data from October 1, 2015 through March 31, 2015 • Challenges physicians face when treating sinusitis -Patient expectations and understanding – education of the patient is VERY important! -Pressure to satisfy the patient – “But my previous doctor ALWAYS gave me antibiotics for this!” -What to do in borderline cases – patient right on the cusp going into a weekend
Act • Data is being collected! Still preliminary, but early results are favorable! • Again, our goal is to use less antibiotics, but perhaps more importantly, have our patients understand why! • As a practice, we have the opportunity to engage in continuing discussions concerning proper techniques to explain to patients why or why not antibiotics are indicated. • The Choosing Wisely Campaign also provides recommendations for appropriate management of other common medical concerns, such as low back pain, cervical cancer screening, and carotid artery stenosis screening.
Act
Historical
Post - Intervention
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Thank you! • Special thanks to Brandye Singleton, Compliance and Education Specialist and David Aufdencamp, GME Director of Operations for their input and IT support!!!
• QUESTIONS???
What are your reflections and questions?
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Healthcare Transformation Learning Session December 5, 2014
Upcoming Regional Learning Sessions
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Please save these dates from 8:30-11:30am: May 15, 2015 August 21, 2015
Happy Holidays!
December 4, 2015