Written by Clay Smith
Physicians who wrote for the most antibiotics were also the ones who diagnosed sinusitis most often. To justify writing for an antibiotic, there was a coding bias to call it “sinusitis” when in fact, it probably was just a cold.
Why does this matter?
Antibiotic stewardship is critical in reducing resistance and adverse effects. Overuse of outpatient antibiotics is a major driver of inappropriate antibiotic use. Treating sinusitis appropriately is a key target to reduce prescribing.
If I call it sinusitis, that makes it true, right?
This was a group of about 13,025 telemedicine visits for respiratory tract infection (RTI) among 105 physicians. Nearly half (49%) of all encounters were coded as sinusitis. The highest quartile prescribers of antibiotics wrote for antibiotics 87% of the time (group 4 in the figure); the lowest, 40% (group 1). The lowest prescribers diagnosed sinusitis 35% of the time, and the highest prescribers 59% of the time. See figure from the cited article below. Patients were randomly assigned to physicians, so the types of RTI should have been evenly distributed among them. Meaning, physicians in the highest prescribing quartile were labeling “other RTI” (aka a cold) as “sinusitis” far more often than the lower prescribers. Of course, this was a telemedicine sample, which may not reflect other retail, urgent care, or ED settings. The take home point is this – clinicians who are prone to write prescriptions for antibiotics may justify their prescribing habits by coding for a diagnosis for which an antibiotic is appropriate, when in reality, the patient just has a cold. It’s important to be circumspect about our own prescribing habits and recognize these biases which impact our prescribing.
Coding Bias in Respiratory Tract Infections May Obscure Inappropriate Antibiotic Use. J Gen Intern Med. 2019 Jun;34(6):806-808. doi: 10.1007/s11606-018-4823-x.
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Reviewed by Thomas Davis