Antibiotic Stewardship Education for the Treatment of Sinusitis in Primary Care

Purpose: This quality improvement and professional development research project aimed to educate ambulatory care providers in southern Arizona on the most recent sinusitis clinical practice guideline and offer key patient communication strategies for discussing sinusitis treatment.Background: Acute sinusitis is a common condition, accounting for 20 million annual visits to an ambulatory setting in the United States (US). Providers frequently prescribe antibiotics for sinusitis even though most infections are of viral origin or are self-limiting. This practice increases the risk of antibiotic resistance and adverse drug reactions. To reduce inappropriate antibiotic use, continuing education of providers on current guidelines and methods for communicating with patients is necessary. Methods: Guided by the Model for Improvement, participants completed online education that included a recorded presentation and two downloadable handouts. The full clinical practice guideline was also available to participants. After reviewing the education, participants completed an online retrospective pretest and posttest survey with questions pertaining to demographics, awareness of antibiotic resistance, knowledge of sinusitis guidelines, perceived patient satisfaction, and intent to prescribe antibiotics. Results: Fourteen nurse practitioners from a variety of primary care and ambulatory settings completed the education and the retrospective pretest and posttest survey. After completing the education, 93% of nurse practitioners stated that they intended to use watchful waiting or delayed antibiotic prescriptions most of the time or almost always, versus 57% before the education. However, only 36% correctly answered a scenario-based question. Provider responses to other outcome measures were positive, but median changes in the Likert scale scores were modest. Conclusions: The online education provided did increase nurse practitioners’ intent to prescribe less antibiotics for acute sinusitis patients. However, the education may not have been effective in helping providers determine which patients qualify for watchful waiting. The education also increased providers’ familiarity with the clinical practice guideline and their perceived ability to educate and better communicate with patients. A larger sample size and more work are needed to better quantify the impact of this educational intervention