Office Evaluation and Treatment of Elderly Patients with Acute Bronchitis

Objectives: To assess the office evaluation of seniors with uncomplicated acute bronchitis and to determine the association between elements of the clinical evaluation and antibiotic prescribing decisions. Design: Cross-sectional chart review. Setting: Seventy-seven community-based office practices in the Denver metropolitan area. Participants: Elderly fee-for-service Medicare patients. Measurements: Medicare administrative data to identify patients with acute bronchitis; medical record review to confirm the diagnosis and record other clinical data. Results: Of 198 elderly patients with acute bronchitis, the mean age±standard deviation was 76±8.6; 53% had at least one comorbid condition. Clinically important vital signs were frequently not recorded; temperature was missing from 34% of charts and pulse from 50% of charts. When recorded, significant vital sign abnormalities were uncommon, with 7% having a temperature of 100°F and 8% having a pulse of 100 beats per minute or greater. However, antibiotics were prescribed to 83% of patients, with more than half of these prescriptions being for extended-spectrum antibiotics. Treatment with antibiotics was more common in men than women (92% vs 78%, P=.007) but was not associated with clinical factors including vital sign measurement, vital sign results, chest radiography, patient age, duration of illness, or the presence of comorbidities. Conclusion: The vast majority of seniors with acute bronchitis are treated with antibiotics, regardless of patient characteristics or the type of evaluation received. Reducing inappropriate antibiotic use in seniors with acute bronchitis may depend on improving the evaluation of these patients and encouraging clinicians to act appropriately on the results.