Antibiotic prescription for acute rhinosinusitis: Emergency departments versus primary care providers.

OBJECTIVES/HYPOTHESIS: We have previously identified patient characteristics associated with emergency department (ED) rather than primary-care provider (PCP) presentation for uncomplicated acute rhinosinusitis (ARS). Here we investigate potential disparities in prescription of antibiotics for patients presenting to a PCP versus ED for uncomplicated ARS.

STUDY DESIGN: Cross-sectional study of the 2005 to 2010 National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Surveys.

METHODS: A total of 37,975,715 patient presentations for uncomplicated ARS to PCPs and EDs. The primary outcome measure was prescription of an oral antibiotic, which was tested for association with clinical setting (PCP vs. ED) and clinical, demographic, and socioeconomic patient characteristics.

RESULTS: Among adult ARS presentations, 57.0% received an antibiotic prescription from a PCP versus 59.1% in the ED. Pediatric patients also were commonly prescribed antibiotics by PCPs (52.9%) and EDs (51.4%). Compared to PCPs, EDs were not associated with antibiotic prescription for adults (odds ratio [OR] = 1.09, 95% confidence interval [CI]: 0.79-1.50, P = 0.613) or children (OR = 0.94, 95% CI: 0.51-1.72, P = 0.840). Among PCP visits, antibiotic prescription was more likely in the Northeast United States (OR = 2.90, 95% CI: .31-6.38, P = 0.009). No other demographic, clinical, or socioeconomic patient characteristics, including insurance status, were associated with antibiotic prescription by PCPs or EDs.

CONCLUSION: More than half of ARS patients presenting to PCPs and EDs are prescribed antibiotics. There was no differential antibiotic prescription for ED versus PCP presentation. ARS patients in the Northeast were more likely to receive antibiotics from PCPs, whereas no such variation was seen for EDs. Interventions targeting PCPs, especially in the Northeast, may reduce excessive antibiotic utilization.

LEVEL OF EVIDENCE: 4. Laryngoscope, 126:2439-2444, 2016.