Clinical and economic outcomes of an ambulatory urinary tract infection disease management program

Objective: To evaluate the effectiveness of a urinary tract infection disea se management program. Study Design: A pre-post design was used. One year of data before and after promoting the treatment guideline were compared. Participants and Methods: A 300,000-member managed care organization introd uced an antibiotic treatment guideline designed to change the antibiotic pr escribing practices of community physicians. The study intervention was the promotion of a treatment guideline through mailings and face-to-face inter ventions by 2 disease management specialists. A relational database was cre ated to measure changes in healthcare resources, use of antibiotics, and he alth event profiles. Results: The study demonstrated that prescribing patterns could be modified through treatment guideline distribution and race-to-face discussions. The study also found similar success rates across a range of antibiotics. Aver age health event costs decreased by 36% Tor kidney infections (P =.696) and by 7% for bladder infections (P < .05) after the treatment guideline was i mplemented; however, when controlling for patient age, sex, and comorbiditi es, the econometric model did not find a reduction in health event costs fo r either kidney or bladder infections. Fluoroquinolones were a cost driver compared with Ether antibiotics used to treat kidney and bladder infections . Conclusions: Consideration should be given to expanding the number of well- established antibiotics on the treatment guideline. Also, fluoroquinolones should be reserved for patients with sulfa allergies or failures with initi al antibiotic treatment. In addition, it is recommended that future costs a nd outcomes be assessed after changes are made to the treatment guideline.