Research ArticleOriginal Research

Roles of Clinician, Patient, and Community Characteristics in the Management of Pediatric Upper Respiratory Tract Infections

Jeffrey P. Yaeger, Jonathan L. Temte, Lawrence P. Hanrahan and P. Martinez-Donate
The Annals of Family Medicine November 2015, 13 (6) 529-536; DOI: https://doi.org/10.1370/afm.1856

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Geographic distribution of patients in the PHINEX database exchange.

    PHINEX = Public Health Information Exchange.

  • Figure 2
    Figure 2

    Percentages of patients receiving appropriate treatment of URI, 2007–2012.

    HEDIS = Healthcare Effectiveness Data and Information Set; NCQA = National Committee on Quality Assurance; PHINEX = Public Health Information Exchange; URI = upper respiratory tract infection.

    NCQA data from National Committee for Quality Assurance. Improving Quality and Patient Experience: The State of Health Care Quality 2013. Washington, DC: National Committee for Quality Assurance; 2013.

  • Figure 3
    Figure 3

    Results of multivariate analysis.

Tables

  • Table 1

    Demographic Characteristics of Study Population

    CharacteristicPatients With URI N = 20,581Patients Who Received Antibiotics n = 1,343
    Year of encounter, No. (%)
     20073,071 (15)193 (6.3)
     20083,244 (16)223 (6.9)
     20094,336 (21)279 (6.4)
     20103,367 (16)204 (6.1)
     20113,369 (16)238 (7.1)
     20123,194 (16)206 (6.4)
    Age, No. (%)
     3 mo to 4 y12,314 (60)707 (5.7)
     5–11 y5,036 (24)347 (6.9)
     12–18 y3,231 (16)289 (8.9)
    Sex, No. (%)
     Female10,217 (50)681 (6.7)
     Male10,364 (50)662 (6.4)
    Race, ethnicity, No. (%)
     White (non-Hispanic)16,007 (80)1,112 (6.9)
     Other (non-Hispanic)1,094 (5)52 (4.8)
     Hispanic1,385 (7)76 (5.5)
     Black (non-Hispanic)1,506 (8)66 (4.4)
    Department, No. (%)
     Family medicine6,803 (33)491 (7.2)
     Urgent care3,987 (19)390 (9.8)
     Pediatrics9,791 (48)462 (4.7)
    Comorbidities, No. (%)
     Yes4,730 (23)344 (6.5)
     No15,851 (77)999 (6.3)
    Health insurance, No. (%)
     Medicaid3,506 (17)187 (5.3)
     None2,901 (14)270 (9.3)
     Commercial14,174 (69)886 (6.3)
    Urbanization, No. (%)
     Suburban10,723 (55)748 (7.0)
     Rural3,072 (16)213 (6.9)
     Urban5,714 (29)324 (5.7)
    Community economic hardship index, No. (%)
     <201,724 (9)115 (6.7)
     20 to <3016,379 (84)1,088 (6.6)
     ≥301,408 (7)82 (5.8)
    Community education level (percentage with some college education), No. (%)
     <50%1,842 (9)143 (7.8)
     50% to <70%7,382 (38)482 (6.5)
     ≥70%10,285 (53)660 (6.4)

    • URI = upper respiratory tract infection.

  • Table 2

    Results of Univariate Analysis

    CharacteristicCrude OR (95% CI)P Value
    Year
     20070.98 (0.81–1.18).79
     20081.07 (0.9–1.29).45
     20091.00 (Reference)–
     20100.94 (0.78–1.13).5
     20111.11 (0.92–1.32).27
     20121.00 (0.83–1.21).98
    Department
     Family medicine1.57 (1.38–1.79)<.001
     Urgent care2.19 (1.9–2.52)<.001
     Pediatrics1.00 (Reference)–
    Age
     5–11 y1.22 (1.1–1.39).004
     12–18 y1.61 (1.4–1.86)<.001
     3 mo to 4 y1.00 (Reference)–
    Sex
     Female1.05 (0.94–1.17).42
     Male1.00 (Reference)–
    Race/ethnicity
     White (Non-Hispanic)1.63 (1.26–2.1)<.001
     Other (Non-Hispanic)1.09 (0.75–1.58).65
     Hispanic1.27 (0.9–1.78).17
     Black (Non-Hispanic)1.00 (Reference)–
    Comorbidities
     Yes1.17 (1.03–1.32).02
     No1.00 (Reference)–
    Health insurance
     Medicaid0.84 (0.72–0.99).04
     None1.54 (1.34–1.78)<.001
     Commercial1.00 (Reference)–
    Urbanization
     Suburban1.25 (1.09–1.43).001
     Rural1.24 (1.04–1.48).02
     Urban1.00 (Reference)–
    Community economic hardship index
     20 to <301.00 (0.82–1.22).96
     ≥300.87 (0.65–1.16).33
     <201.00 (Reference)–
    Community education level (percentage with some college education)
     <50%1.23 (1.02–1.48).03
     50 to <70%1.02 (0.9–1.15).76
     ≥70%1.00 (Reference)–

Additional Files

  • The Article in Brief

    Roles of Clinician, Patient, and Community Characteristics in the Management of Pediatric Upper Respiratory Tract Infections

    Jeffrey P. Yaeger , and colleagues

    Background Previous studies have examined patient and clinician factors associated with inappropriate prescribing of antibiotics for upper respiratory infections (URIs) in children. This is the first study to use electronic health record and community data to evaluate patient, clinician and community factors affecting the management of pediatric upper respiratory infections.

    What This Study Found White children, adolescents, and children seen at non-pediatric clinics are at increased risk of receiving antibiotics for URIs. In this study, patients seen in family medicine and urgent care clinics are 1.5 and 2.23 times as likely to be prescribed antibiotics as those seen in pediatric clinics, respectively. After controlling for other factors, adolescents and white patients are 1.4 and 1.8 times as likely to be prescribed antibiotics, respectively. No community factors are independently predictive of antibiotic prescription.

    Implications

    • These findings are consistent with prior studies in which non-pediatric clinicians and white race were predictive of antibiotic prescription, illustrating the promise of linking electronic health records with community data to evaluate antibiotic prescription in children as well as health care disparities.
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