Ep. Armstrong, Clinical and economic outcomes of an ambulatory urinary tract infection disease management program, AM J M CARE, 7(3), 2001, pp. 269-280
Citations number
56
Categorie Soggetti
Public Health & Health Care Science","Health Care Sciences & Services
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.