Pharyngitis Guidelines Are Inconsistently Followed
Researchers observed low adherence to the Infectious Diseases Society of America’s clinical practice guidelines for group A streptococcal pharyngitis (GAS), although a quality improvement initiative, implemented during the study, improved these outcomes.
“The Infectious Diseases Society of America (IDSA) clinical practice guideline for group A streptococcal (GAS) pharyngitis recommends strict criteria for GAS testing to avoid misdiagnosis and unnecessary treatment of children who are colonized with group A Streptococcus,” the researchers wrote. “We sought to improve adherence to the IDSA guideline for testing and treatment of GAS pharyngitis in a large community pediatrics practice.”
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They implemented a Model for Improvement using Plan-Do-Study-Act cycles at a practice including 16 physicians. The intervention included provider education, modification of existing procedure, communication strategies, and patient education.
Overall, following the implementation of the quality improvement initiative, unnecessary GAS testing decreased 23.5% (from 64% to 40.5%). The presence of viral symptoms was the primary reason for unnecessary testing, and inappropriate antibiotic use was primarily related to unnecessary testing. However, rates of appropriate antibiotic use did not change significantly during the study.
“The majority of GAS pharyngitis testing in this practice before intervention was inconsistent with IDSA guideline recommendations. A quality improvement initiative, which was approved for Part 4 Maintenance of Certification credit, led to improvement in guideline-based testing for GAS pharyngitis.”
—Michael Potts
Reference:
Norton LE, Lee BR, Harte L, et al. Improving guideline-based streptococcal pharyngitis testing: a quality improvement initiative [published online June 20, 2018]. Pediatrics. doi: 10.1542/peds.2017-2033.