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Physician Specialty Is Associated With Differences in the Evaluation and Management of Acute Bacterial Rhinosinusitis
John W. Werning, MD, DMD;
Todd W. Preston, MD;
Sadik Khuder, PhD
Arch Otolaryngol Head Neck Surg. 2002;128:123-130.
Background Acute bacterial rhinosinusitis (ABRS) is a common illness that is routinely
managed by physicians from several different specialties. However, the actual
diagnostic and treatment preferences of physicians from these different specialties
are not known.
Objective To determine whether the radiographic evaluation and management of community-acquired
ABRS differs according to medical specialty.
Design, Setting, and Participants Randomized survey of 450 board-certified physicians in the United States
from family medicine, general internal medicine, and otolaryngology.
Main Outcome Measures Responding physicians' use of diagnostic radiography as well as choice
and duration of antimicrobial and adjunctive treatments of ABRS.
Results Otolaryngologists were more likely to use supportive diagnostic radiography
(P = .04). They were also more likely to treat patients
with adjunctive therapy, such as topical decongestants (P = .01), guaifenesin (P = .01), and saline
nasal irrigation (P = .01), in addition to antibiotics.
Otolaryngologists prescribed more medications to treat patients with ABRS
than primary care physicians (P = .01). There were
no significant differences in diagnosis and management by family physicians
and general internists.
Conclusions Otolaryngologists use more health care resources to diagnose and treat
ABRS than primary care physicians despite an absence of evidence that such
tests and treatments lead to better outcomes. Otolaryngologists typically
treat a patient population with a higher prevalence of ABRS and frequently
see referred patients with recurrent acute sinusitis and chronic rhinosinusitis,
which may explain their tendency to treat patients more aggressively. Nevertheless,
these survey results illustrate a lack of consensus within the medical community
regarding the evaluation and management of community-acquired ABRS, suggesting
that widely accepted evidence-based practice guidelines need to be developed.
From the Departments of Otolaryngology–Head and Neck Surgery
(Drs Werning and Preston) and Medicine (Dr Khuder), Medical College of Ohio,
Toledo. Dr Werning is a consultant for Pfizer Inc, New York, NY, and UCB Pharma
Inc, Atlanta, Ga.
RELATED ARTICLE
Archives of Otolaryngology–Head & Neck Surgery Reader's Choice: Continuing Medical Education
Arch Otolaryngol Head Neck Surg. 2002;128(2):202-203.
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