Annals
Established in 1927 by the American College of Physicians

FOR THE PRESS

7 August 2012 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians on the first and third Tuesday of every month. These highlights are not intended to substitute for articles as sources of information. For a copy of an article, call 215-351-2653 or e-mail Angela Collom at acollom@acponline.org

1. Tuning into Contextual Clues May Help Doctors Improve Antibiotic Prescribing Habits

Appropriate use of antibiotics can improve patient outcomes and reduce risk for antibiotic resistance. Febrile respiratory illnesses, or FRI, often present with vague, cold-like symptoms, making it difficult to discern whether the illness is viral or bacterial. Since there are few bedside clues that reliably distinguish viral from bacterial, physicians rely on contextual factors to aid treatment decisions. Contextual factors include epidemiology (for example, flu pandemic period) and recent clinical experience (for example, the number of patients seen in the past week with similar symptoms). Researchers studied electronic health records for 28,301 patients presenting with FRI during flu seasons between 2006 and 2011 to examine how context influences physicians' antibiotic prescribing habits. They found that physicians were more likely to prescribe antibiotics during flu season, but significantly less likely to do so during a pandemic period. Prescriptions for antivirals increased from 5.5 percent of all FRI encounters during flu season to 12.6 percent during pandemic. Physicians who saw 12 or more patients with FRI in the previous week were less likely to prescribe antibiotics and more likely to prescribe antivirals. According to the researchers, teaching physicians to pay attention to contextual clues may improve appropriate prescribing of antibiotics. Informatics tools could provide clinicians with locally relevant, up-to-date data on epidemiological factors. This could be another meaningful use for electronic health records.

2. Consider Blacks and Whites the Same When Evaluating HbA1C Levels for Diabetes Diagnosis

Recent studies have highlighted racial differences in hemoglobin A1C (HbA1C) levels. At the same blood glucose levels, black patients have higher HbA1C levels than white patients. This distinction has led some experts to propose setting a higher HbA1C threshold for diagnosing diabetes in black patients. Retinopathy (damage to the retina that can lead to blindness) is a common complication of diabetes. Retinopathy can be prevented if diabetic patients are diagnosed and treated early. Researchers studied 2,408 white patients and 1,008 black patients aged 40 or older to compare the relationships between HbA1C level and the prevalence of retinopathy. The researchers found that the prevalence of retinopathy begins to increase at a lower HbA1C level in black patients than in white patients. For this reason, the authors recommend against setting a higher diagnostic threshold of HbA1C in black patients.