Patient education is key to reducing antibiotics for pharyngitis
Doctors can go a long way toward changing public attitudes about antibiotic use. That’s what Dr. Paul Turke strives for in his Chelsea family practice. He and his partner have maintained a practice culture that avoids antibiotics when unnecessary.
“Our office is successful [in avoiding unnecessary antibiotics] because we set the groundwork early with patients,” says Dr. Turke. “We spend quite a bit of time talking about how antibiotics are great tools, but if they are used when they’re not needed they can be detrimental to a patient and the population at large,” he adds.
Dr. Turke has 100 percent compliance on the HEDIS® measure that focuses on performing strep tests on children with acute pharyngitis. “We do a rapid strep test on nearly every patient who complains of a sore throat,” says Dr. Turke. “If it’s positive, we treat. If not, we don’t. If we’re not certain, we will send out for a culture.”
The doctor starts conversations early with new patients and families considering transferring to his office. “A lot of patients are now tuned into this problem as well,” he says.
The conversation happens throughout the patient-doctor relationship, not just during the initial visit so patients know what to expect when they come to the office. “Our patients are already prepared when they come here with symptoms,” says Dr. Turke. “We’ve already discussed with them the importance of good bacteria and of not disrupting the human microbiome.”
Simply letting patients know that you are available after hours can prevent them from getting prescriptions elsewhere, says Dr. Turke. “Sometimes patients come in and have already been prescribed an antibiotic from an urgent care center. Since I wasn’t there when the urgent care doctor was looking at the patient, I don’t challenge the use of the antibiotic,” says Dr. Turke. “What I do tell patients is some things can wait. I remind them we always save office time for sick patients. It’s often just a matter of giving them pain relief and seeing them the next day. By knowing a patient’s history, we can be more judicious,” he says.
Dr.Turke also says he reminds patients to call the office, even when they are closed. “Patients know we are available 24 hours a day with our after-hours service,” he says. ”I tell them I can often save them a trip to the emergency room. I’ll never take chances with their children, but I can often get them through the night until they can come into the office,” he adds.
Nurses are also available to answer questions when patients call. Nurses may also encourage patients to come into the office before the end of the day instead of waiting. That way the patient doesn’t feel the need to go to urgent care if symptoms worsen after hours.
What else can doctors do to help patients understand the role of antibiotics?
“I’m intrigued about some of the new literature about good bacteria and human microbiomes,” says Dr. Turke. “Having physicians read about that gives them some ammunition to tell patients that good bacteria can affect everything from mood to immune function and we’re disrupting those with frequent prescriptions. Physicians may be busy, but if you stop and read the literature, it gives you a better tool for explaining to patients what the downside is.”