Antibiotic Prescribing for Acute Respiratory Infection and Subsequent Outpatient and Hospital Utilization in Veterans With Spinal Cord Injury and Disorder
Received 20 August 2009; accepted 4 November 2009. published online 01 February 2010.
Objective
To assess the association between antibiotic prescribing for acute respiratory infection (ARI) and subsequent health-care utilization in veterans with spinal cord injury and disorder (SCI/D).
Design
Retrospective cohort of veterans with SCI/D.
Setting
Veterans Affairs medical facilities that provide outpatient care.
Patients
Veterans with SCI/D with a diagnosis of acute bronchitis or upper respiratory infection during an outpatient visit between fiscal year 2006 and 2007 that did not result in same-day hospitalization.
Independent Variable
Receipt of a new antibiotic prescription occurring within 3 days before or after an ARI visit.
Main Outcome Measure
Subsequent outpatient visit or hospitalization within 30 days of the index ARI visit.
Results
A total of 1277 patients were identified with ARI; 53.2% were prescribed an antibiotic. An outpatient clinic visit within 30 days of the index ARI visit occurred in 47.0% of patients. Receipt of an antibiotic prescription was not associated with a subsequent outpatient visit. However, in those with certain chronic respiratory conditions (cough, shortness of breath, bronchitis not specified as acute or chronic, and allergic rhinitis), those prescribed antibiotics were less likely to return for an outpatient visit than those not prescribed antibiotics (adjusted relative risk =0.77, 95% confidence interval = 0.61-0.97); no association was observed in those patients without these conditions. A total of 7.9% of patients were hospitalized within 30 days and did not differ by prescribing group. The 30-day mortality rate was 0.6%.
Conclusions
Certain chronic respiratory conditions in veterans with SCI/D may be risk factors for increased health-care utilization and potentially poor outcomes if a patient is not treated with antibiotics for ARI. However, in those without these conditions, those with ARI who were prescribed antibiotics have similar utilization to those not prescribed antibiotics. These data suggest that in the absence of chronic respiratory conditions, antibiotic use for ARI can be curbed in this population that is at high risk for respiratory complications.
aDepartment of Veterans Affairs (VA), Center for Management of Complex Chronic Care, Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. VA Hospital (151H), 5th Avenue and Roosevelt Road, P.O. Box 5000, Room D302, Hines; and Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL†
bDepartment of VA, Center for Management of Complex Chronic Care, Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. VA Hospital, Hines; and Department of Preventive Medicine, Northwestern University, Chicago, IL‡
cVA Puget Sound Health Care System and University of Washington, Seattle, WA§
dDepartment of VA, Center for Management of Complex Chronic Care, Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. VA Hospital, Hines; and Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL¶
eDepartment of VA, Center for Management of Complex Chronic Care, Edward Hines Jr. VA Hospital, Hines; and University of Illinois at Chicago, Chicago, IL∥
fDepartment of VA, Center for Management of Complex Chronic Care, Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. VA Hospital, Hines; Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago; and Department of Neurology, Northwestern University, Chicago, IL#
Address correspondence to C.T.E.
Supported by the Department of Veterans Affairs, Office of Research and Development, Health Services Research and Development Service Locally Initiated Project (LIP 42-503), and the Paralyzed Veterans of America Research Foundation (Project #2562).
Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org
† Disclosure: 8B, Paralyzed Veterans of America Research Foundation
ABSTRACT