HEDIS Respiratory Quality Measure
Transcription
HEDIS Respiratory Quality Measure
To: Providers to FHCP Members From: FHCP Quality Management Date: February 7, 2014 Subject: HEDIS Respiratory Quality Measures 2014 Update, & Resource Tools FHCP’s Quality Management Department shares your goal of delivering high quality care. We follow current clinical practice guidelines for respiratory conditions and are monitored on an ongoing basis by HEDIS (Healthcare Effectiveness Data and Information Set). HEDIS is a widely used set of quality measures developed by the National Committee for Quality Assurance (NCQA) to ensure high healthcare standards. Enclosed is updated information for the HEDIS 2014 specifications relating to respiratory conditions, i.e. Asthma, COPD (for Adult Members Only), Pharyngitis/Strep Tests, Upper Respiratory Infections, Acute Bronchitis (for Adult Members Only), and use of Antibiotics. Provided is a brief description of these quality measures for 2014, along with steps you and your staff can take to ensure compliance with recommended clinical guidelines. Coding requirements and medication lists are also included when applicable. Please help us ensure optimal patient care by taking the time to read the summary of the 2014 specifications and using them in your treatment of FHCP patients. Clinical Practice Guidelines and the attached Respiratory Conditions office resource tools and CDC fact sheets are on our website at http://www.fhcp.com/providers/medical-guidelines/. For questions concerning these quality measures, or to request copies of any materials, please call Quality Management @ 676-7100, ext. 7258 or email [email protected]. Thank you for all you do on behalf of FHCP members and their continued health and wellness. cc: Joseph Zuckerman, M.D., Chief Medical Officer Changes to HEDIS ASM 2014 include: Coding tables were replaced with value set references, and 3 medications (none on formulary) were removed from ASM-D, Asthma Controller Medications. Use of Appropriate Medications for People With Asthma (ASM) Description of the 2014 ASM measure: The measure looks at members 5-64 years of age who were identified as having persistent asthma and who were prescribed appropriate controller medication during the measurement year. Patients with persistent asthma are identified as having met at least one (1) of the following criteria during both the measurement year and the year prior: At least one ED visit with asthma as the principal diagnosis. At least one acute inpatient claim/encounter with asthma as the principal diagnosis. At least four (4) outpatient asthma visits on different dates of service, with asthma as one of the listed diagnoses and at least two asthma medication dispensing events. At least four asthma medication dispensing events. Generally, the majority of patients who fall onto the ASM Non-Compliant list have received 4 or more fast acting rescue inhalers within each year, without the addition of an asthma controller medication. Steps you can take: 1. If your patient has persistent asthma and is not on a controller medication, please review and consider initiation of this treatment as recommended in the Asthma Guidelines Summary for the diagnosis and management of asthma. See attached ASM-D: Asthma Controller Medications (new list for 2014). 2. Be aware that the patient will state their symptoms are under control (per their perception) while using frequent rescue inhalers. Additional refills are requested, and use of a suppressant/controller medication is not addressed. Monitor the # of rescue inhalers the patient is refilling. 3. Explain to the patient that using an asthma controller medication should lessen asthma exacerbations and the need for rescue inhalers. 4. If your patient has been dispensed a sample controller medication, please fax a copy to Quality Management, Fax # (386) 481-5088, Attn: ASM Measure. To view the Asthma Guidelines Summary, go to: http://www.fhcp.com/providers/medical-guidelines/clinical-practice-guidelines FHCP Quality Management, Spring 2014 2014 HEDIS Specifications ASM-D: Asthma Controller Medications RED indicates those available on FHCP formulary. Please refer to formulary for updates. Description Prescriptions Antiasthmatic combinations dyphylline-guaifenesin (COPD, Dilor-G, Lufyllin-Gc) guaifenesin-theophylline (Bronkaid, Quibron, Quibron-300) Antibody inhibitor omalizumab (Xolair) Inhaled steroid combinations budesonide-formoterol (Symbicort) fluticasone-salmeterol (Advair) mometasone-formoterol (Dulera) Inhaled corticosteroids beclomethasone (Qvar) flunisolide (Aerobid) mometasone (Asmanex) budesonide (Pulmicort Respules) (Peds only) fluticasone CFC free (Flovent) triamcinolone (Azmacort) ciclesonide (Alvesco) Leukotriene modifiers montelukast (Singulair) zafirlukast (Accolate) zileuton (Zyflo) Mast cell stabilizers cromolyn (Intal) Methylxanthines aminophylline (Phyllocontin, Truphylline) theophylline (Theo-Dur, Respbid, Slo-Bid, Theo-24, Theolair) dyphylline (Dilor, Dylix, Lufyllin) Medication Management for People With Asthma (MMA) Description of the 2014 ASM measure: The percentage of members 5–64 years of age during the measurement year who were identified as having persistent asthma and were dispensed appropriate medications that they remained on during the treatment period. Two rates are reported: 1. The percentage of members who remained on an asthma controller medication (ASM-D) for at least 50% of their treatment period. 2. The percentage of members who remained on an asthma controller medication (ASM-D) for at least 75% of their treatment period. Asthma Medication Ratio (AMR) Description of the 2014 ASM measure: The percentage of members 5–64 years of age who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.50 or greater during the measurement year. Step 1: For each member, count the units of controller medications (AMR-A) dispensed during the measurement year. Each dispensing event is one unit. When inhalers are used, one medication unit equals one inhaler (canister) dispensed. Step 2: For each member, count the units of reliever medications (AMR-A) dispensed during the measurement year. Each dispensing event is one unit. When inhalers are used, one medication unit equals one inhaler (canister) dispensed. Step 3: For each member, sum the units calculated in step 1 and step 2 to determine units of total asthma medications. Step 4: For each member, calculate the ratio of controller medications to total asthma medications using the following formula. Units of Controller Medications (step 1) Units of Total Asthma Medications (step 3) Step 5: Sum the total number of members who have a ratio of 0.50 or greater in step 4. Note: Multiple inhaler dispensing events of the same inhaler medication or a different inhaler medication count as separate dispensing events. For example, two inhalers dispensed on the same or different days count as two dispensing events. FHCP Quality Management, Spring 2014 2014 HEDIS Specifications AMR-A: Asthma Controller and Reliever Medications Description Asthma Controller Medications Prescriptions Antiasthmatic combinations dyphylline- Antibody inhibitors omalizumab Inhaled steroid combinations budesonide- fluticasone- mometasone- Inhaled corticosteroids beclomethasone budesonide ciclesonide flunisolide fluticasone CFC triamcinolone Leukotriene modifiers Mast cell stabilizers montelukast zafirlukast Methylxanthines aminophylline dyphylline Description Short-acting, inhaled beta-2 agonists guaifenesin formoterol guaifenesin- theophylline salmeterol formoterol free mometasone zileuton cromolyn theophylline Asthma Reliever Medications Prescriptions albuterol metaproterenol levalbuterol pirbuterol Note The HEDIS age strata for asthma measures are designed to align with both clinical practice guidelines and reporting requirements for child health quality improvement programs. Clinical guidelines specify appropriate age cohorts for measuring use of asthma medications as 5–11 years and 12–50 years, to account for differences in medication regimens for children vs. regimens for adolescents and adults. Implementation requires further stratification of age ranges to enable creation of comparable cohorts that align with child health populations. Changes to HEDIS CWP 2014 include: Coding tables were replaced with value set references. Appropriate Testing for Children With Pharyngitis (CWP) Description of the 2014 CWP measure: The percentage of children 2 – 18 years of age who were diagnosed with Pharyngitis, dispensed an antibiotic and received a Group A streptococcus (strep) test for the episode. A higher rate represents better performance (i.e. appropriate strep testing). To clarify, a strep test should be completed and documented for any patient receiving a diagnosis of Pharyngitis who is prescribed an antibiotic. What we have found for members on the CWP Non-Compliant list: A strep test was not performed for a diagnosis of Pharyngitis, or The code for the strep test was not included on the claim, or Additional diagnoses other than Pharyngitis which are present on office visit notes, have not been included on the actual claim. (This is important because more than 1 diagnosis on the claim, other than Pharyngitis, removes a member from the CWP Non-Compliant list). Pharyngitis Includes: ICD-9 Code Acute Pharyngitis 462 Acute Tonsillitis 463 Streptococcal Sore Throat Codes to Identify Group A Strep Tests 87070, 87071, 87081, 87430, 87650, 87651, 87652, 87880 034.0 Steps you can take: If a member age 2 to 18 has Pharyngitis (which includes Acute Pharyngitis, Acute Tonsillitis, or Streptococcal Sore Throat), and you are prescribing an antibiotic: 1. Please complete a Strep Test. 2. Please include the CPT code for the Group A Strep Test. 3. Please include all diagnosis codes with the claim, if there are any other than Pharyngitis. You may go to http://www.cdc.gov/getsmart/campaign-materials/treatment-guidelines.html to view Pediatric & Adult Treatment Guidelines for various Upper Respiratory Infections. FHCP Quality Management, Spring 2014 Changes to HEDIS URI 2014 include: Coding tables were replaced with value set references. Appropriate Treatment for Children With Upper Respiratory Infection (URI) Description of the 2014 URI measure: The percentage of children 3 months - 18 years of age who were given a diagnosis of Upper Respiratory Infection (URI) and were not dispensed an antibiotic. For Upper Respiratory Infections, it is considered a mark of high quality care if these patients were not dispensed an antibiotic when they only have a diagnosis of a URI, which includes either: Acute Nasopharyngitis –“common cold” (Code 460); or Upper Respiratory Infection (Code 465). As you are aware, Acute Nasopharyngitis (common cold), & Upper Respiratory Infections are usually viral illnesses that do not respond to antibiotics. We understand that many parents do not believe that antibiotics are not always appropriate when their child is sick. It takes everyone in healthcare working together to diminish the use of antibiotics, and to avoid creating resistant strains of bacteria which are dangerous to all of us. Steps you can take: 1. When an antibiotic is being prescribed for one of our members age 3 months to 18 years, with either Acute Nasopharyngitis (common cold – Code 460), or Upper Respiratory Infection (Code 465), please evaluate the use of an additional diagnosis, if appropriate, such as: Otitis Media; Acute Sinusitis; Acute Pharyngitis; Acute Tonsillitis; Chronic Sinusitis; Infections of the Pharynx, Larynx, Tonsils, Adenoids; Bacterial infection unspecified; Pertussis; or Pneumonia. For a complete list, please see attached URI-C: Codes to Identify Competing Diagnoses. 2. If you are unable to add an additional diagnosis from URI-C, please consider not prescribing an antibiotic if using only the diagnoses of Acute Nasopharyngitis (Code 460) and/or Upper Respiratory Infection (Code 465). Per national standards of care as contained in HEDIS specifications, antibiotic use is not recommended for Acute Nasopharyngitis and/or Upper Respiratory Infection. You may go to http://www.cdc.gov/getsmart/campaign-materials/onepage-sheets.html to print education sheets (English/Spanish) to reinforce the decision to parents not to use an antibiotic. FHCP Quality Management, Spring 2014 URI-C: Codes to Identify Competing Diagnoses Description Intestinal infections ICD-9-CM Diagnosis 001-009 Pertussis 033 Bacterial infection unspecified 041.9 Lyme disease and other arthropod-borne diseases 088 Otitis media 382 Acute sinusitis 461 Acute pharyngitis 034.0, 462 Acute tonsillitis 463 Chronic sinusitis 473 Infections of the pharynx, larynx, tonsils, adenoids Prostatitis 464.1-464.3, 474, 478.21-478.24, 478.29, 478.71, 478.79, 478.9 601 Cellulitis, mastoiditis, other bone infections 383, 681, 682, 730 Acute lymphadenitis 683 Impetigo 684 Skin staph infections 686 Pneumonia 481- 486 Gonococcal infections and venereal diseases 098, 099, V01.6, V02.7, V02.8 Syphilis 090-097 Chlamydia 078.88, 079.88, 079.98 Inflammatory diseases (female reproductive organs) 131, 614-616 Infections of the kidney 590 Cystitis or UTI 595, 599.0 Acne 706.0, 706.1 CAREFUL ANTIBIOTIC USE To avoid antibiotic resistance: treat only proven group A strep PHARYNGITIS IN CHILDREN1 “If you are entirely comfortable selecting which pharyngitis patients to treat 10 days with penicillin, perhaps you don’t understand the situation.” - Stillerman and Bernstein, 1961 ■ Most sore throats are caused by viral agents.2 Experts discourage treatment pending culture results5-6, but if you do... ■ Make sure to stop antibiotics when culture is negative. ■ Discourage parents from saving antibiotics. If an antibiotic is prescribed: ■ Use a penicillin as treatment for group A strep.7 NO group A strep are resistant to penicillin. Treatment is 90% effective at elimination of strep, and may be higher in the prevention of acute rheumatic fever (ARF). Carriers are at very low risk for both ARF and spreading infection. 7 ■ Use erythromycin if penicillin ■ Clinical findings alone do not adequately distinguish Strep vs. Non-Strep pharyngitis. 3 BUT, prominent rhinorrhea, cough, hoarseness, conjuntivitis, or diarrhea suggest a VIRAL etiology. 4 ■ Antigen tests (rapid Strep kits) or culture should be positive before beginning antibiotic treatment. Experts suggest confirming negative results on antigen tests with culture. 5 Remember that most cases with clinical signs of strep, like exudate and adenopathy, are viral. allergic. References 1. Schwartz B, Marcy SM, Phillips WR, Gerber MA, Dowell SF, Pharyngitis-principles of judicious use of antimicrobial agents. Pediatrics 1998;101:171-174 2 . Tanz RR, Shulman ST. Diagnosis and treatment of group A streptococcal pharyngitis. Semin Pediatr Infect Dis 1995;6:69-78. 3 . Poses RM, Cebul RD, Collins M, et al. The accuracy of experienced physicians’ probability estimates for patients with sore throat: implications for decision making. JAMA 1985;254:925-29. 4 . Denson MR. Viral pharyngitis. Semin Pediatr Infect Dis 1995;6:62-68. 5 . American Academy of Pediatrics. Group A streptococcal infections. In: Pickering LK, ed. 2000 Red Book: Report of the Committee on infectious Diseases. 25th ed. Elk Grove, IL: American Academy of Pediatrics; 2000:528. 6 . Middleton DB, D’ Amico FD, Merenstein JH. Standardized symptomatic treatment versus penicillin as initial therapy for streptococcal pharyngitis. J Pediatr 1988;113:1089-94. 7 . Shulman ST, Gerber MA, Tanz RR, Markowitz M. Streptococcal pharyngitis: the case for penicillin therapy. Pediatr Infect Dis J 1994;13:1-7. CAREFUL ANTIBIOTIC USE Cough illness in the well-appearing child: Antibiotics are NOT the answer. COUGH ILLNESS/BRONCHITIS1 Cough illness/bronchitis is caused by viral pathogens.2 inflammation and sputum are non-specific responses imply a bacterial etiology. principally Airway production and do not Authors of a meta-analysis of six randomized trials (in adults) concluded that antibiotics were ineffective in treating cough illness/bronchitis.3 Antibiotic treatment of upper respiratory infections do not prevent bacterial complications such as pneumonia.4 ■ When parents demand antibiotics... Acknowledge the child’s symptoms and discomfort. Promote active management with non-pharmacologic treatments. Give realistic time course for resolution. Share the CDC/AAP principles and pamphlets with parents to help them understand when the risks of antibiotic treatment outweigh the benefits. References ■ Do not use antibiotics for: Cough <10-14 days in well-appearing child without physical signs of pneumonia. ■ Consider antibiotics only for: Suspected pneumonia, based on fever with focal exam, infiltrate on chest x-ray, tachypnea, or toxic appearance. Prolonged cough (>10-14 days without improvement) may suggest specific illnesses (e.g. sinusitis) that warrant antibiotic treatment. 5 Treatment with a macrolide (erythromycin) may be warranted in the child older than 5 years when mycoplasma or pertussis is suspected. 6 1.OBrien KL, Dowell SF, Schwartz B, Marcy SM, Phillips WR, Gerber MA. Cough illness/bronchitisprinciples of judicious use of antimicrobial agents. Pediatrics 1998;101:178-181. 2 .Chapman RS, Henderson FW, Clyde WA, Collier AM, Denny FW. The epidemiology of tracheobronchitis in pediatric practice. Am J Epidemiol 1981;114:789-797. 3 .Orr PH, Scherer K, Macdonald A, Moffatt MEK. Randomized placebo-controlled trials of antibiotics for acute bronchitis: a critical review of the literature. J Fam Pract 1993;36:507-512. 4 .Gadomski AM. Potential interventions for preventing pneumonia among young children: lack of effect of antibiotic treatment for upper respiratory infections. Pediatr Infect Dis J 1993;12:115-120. 5.Wald E. Management of Sinusitis in infants and Children. Pediatr Infect Dis J 1988;7:449-452. 6 .Denny FW, Clyde WA, Glezen WP. Mycoplasma pneumoniae disease clinical spectrum, pathophysiology, epidemiology and control. J Infect Dis 1971;123:74-92. CAREFUL ANTIBIOTIC USE When parents request antibiotics for rhinitis or the “common cold”... Give them an explanation, not a prescription. RHINITIS VERSUS SINUSITIS IN CHILDREN1 Remember: Treating sinusitis: Children have 2-9 viral respiratory illnesses per year.2 In uncomplicated colds, cough and nasal discharge may persist for 14 days or more – long after other symptoms have resolved Duration of symptoms in 139 rhinovirus colds 3 cough nasal discharge fever myalgia sneezing sore throat % of patients with symptom % of patients with symptom 70% 60% 50% 40% 30% 20% 10% 0% 70% 60% 50% 40% 30% 20% 10% 0% 2 3 4 5 6 7 8 9 10 11 12 13 14 day of illness ■ Target likely organisms with first-line drugs: Amoxicillin, Amoxicillin/Clavulanate6 ■ Use shortest effective course: Should see improvement in 2-3 days. Continue treatment for 7 days after symptoms improve or resolve (usually a 10 - 14 day course).7 ■ Consider imaging studies in recurrent or unclear cases: But remember that some sinus involvement is frequent early in the course of uncomplicated viral URI - so interpret studies with caution. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 day of illness Share the CDC/AAP principles and pamphlets with parents to help them understand when antibiotic treatment risks outweigh the benefits. ■ rhinorrhea, fever, and cough are symptoms of Controlled studies do not support antibiotic treatment of mucopurulent rhinitis.4 Antibiotics do not effectively treat URI, or prevent subsequent bacterial infections.5 Don’t overdiagnose sinusitis Though most viral URIs involve the paranasal sinuses, only a small minority are complicated by bacterial sinusitis. Avoid unneccesary treatment by using strict criteria for diagnosis:5 Symptoms of rhinorrhea or persistent daytime cough lasting more than 10 - 14 days without improvement. or Severe symptoms of acute sinus infection: - fever (> 39 C) with purulent nasal dis charge - facial pain or tenderness - periorbital swelling viral URI ■ changes in mucous to yellow, thick, or green are the natural course of viral URI, NOT an indication for antibiotics.8 ■ treating viral URI will not shorten the course of illness or prevent bacterial infection.5 References 1. Rosenstein N, Phillips WR, Gerber MA, Marcy SM, Schwartz B, Dowell SF. The common cold-principles of judicious use. Pediatrics 1998;101:181-184. 2 . Monto AS, Ullman BM. Acute respiratory illness in an American community. JAMA 1974;227:164-169. 3 . Gwaltney JM, Hendley JO, Simon G, Jordan WS. Rhinovirus infections in an industrial population. JAMA 1967;202:158-164. 4 . Todd JK, Todd N, Damato J, Todd WA. Bacteriology and treatment of purulent nasopharyngitis: a double blind, placebo-controlled evaluation. Pediatric Inf Dis J 1984;3:226-232. 5 . Gadomski AM. Potential interventions for preventing pneumonia among young children: lack of effect of antibiotic treatment for upper respiratory infections. Pediatric Infect Dis J 1993;12:115-120. 6. Avorn J, Solomon D. Cultural and economic factors that (mis)shape antibiotic use: the nonpharmacologic basis of therapeutics. Ann of Intern Med 2000:133:128-135. 7 . O’Brien KL, Dowell SF, Schwartz B, et al. Acute sinusitis – prin-ciples of judicious use of antimicrobial agents. Pediatrics 1998;101:174-177. 8 . Wald ER. Purulent nasal discharge. Pediatric Infect Dis J 1991;10:329-333. CAREFUL ANTIBIOTIC USE Stemming the tide of antibiotic resistance: Recommendations by CDC/AAP to promote appropriate antibiotic use in children.1, 2 PEDIATRIC APPROPRIATE TREATMENT SUMMARY DIAGNOSIS Otitis Media CDC/AAP Principles of Appropriate Use 1. Classify episodes of otitis media (OM) as acute otitis media (AOM) or otitis media with effusion (OME). Only treat certain children with proven AOM. 2. A certain diagnosis of AOM meets three criteria: - History of acute onset of signs and symptoms - Presence of middle ear effusion - Signs or symptoms of middle-ear inflammation Severe illness is moderate to severe otalgia or fever ≥ 39C. Non-severe illness is mild otalgia and fever < 39C in the past 24 hours. 3. Children with AOM who should be treated as follows: Age 4. Rhinitis and Sinusitis Pharyngitis Cough Illness and Bronchitis Certain Diagnosis Uncertain Diagnosis < 6 mo Antibacterial therapy Antibacterial therapy 6 mo to 2 y Antibacterial therapy Antibacterial therapy if severe illness; observation option* if nonsevere illness >2y Antibacterial therapy if severe illness; observation option* if nonsevere illness Observation option* Don’t prescribe antibiotics for initial treatment of OME: - Treatment may be indicated if bilateral effusions persist for 3 months or more. * If decision is made to treat with an antibacterial agent, the clinician should prescribe amoxicillin for most children. Rhinitis: 1. Antibiotics should not be given for viral rhinosinusitis. 2. Mucopurulent rhinitis (thick, opaque, or discolored nasal discharge) frequently accompanies viral rhinosinusitis. It is not an indication for antibiotic treatment unless it persists without improvement for more than 10-14 days. Sinusitis: 1. Diagnose as sinusitis only in the presence of: - prolonged nonspecific upper respiratory signs and symptoms (e.g. rhinorrhea and cough without improvement for > 10-14 days), or - more severe upper respiratory tract signs and symptoms (e.g. fever >39C, facial swelling, facial pain). 2. Initial antibiotic treatment of acute sinusitis should be with the most narrow-spectrum agent which is active against the likely pathogens. 1. Diagnose as group A streptococcal pharyngitis using a laboratory test in conjunction with clinical and epidemiological findings. 2. Antibiotics should not be given to a child with pharyngitis in the absence of diagnosed group A streptococcal infection. 3. A penicillin remains the drug of choice for treating group A streptococcal pharyngitis. 1. Cough illness/bronchitis in children rarely warrants antibiotic treatment. 2. Antibiotic treatment for prolonged cough (>10 days) may occasionally be warranted: - Pertussis should be treated according to established recommendations. - Mycoplasma pneumoniae infection may cause pneumonia and prolonged cough (usually in children > 5 years); a macrolide agent (or tetracycline in children ≥ 8 years) may be used for treatment. - Children with underlying chronic pulmonary disease (not including asthma) may occasionally benefit from antibiotic therapy for acute exacerbations. When parents demand antibiotics… Provide educational materials and share your treatment rules to explain when the risks of antibiotics outweigh the benefits. Build cooperation and trust: - Don’t dismiss the illness as “only a viral infection” - Explicitly plan treatment of symptoms with parents - Give parents a realistic time course for resolution - Prescribe analgesics and decongestants, if appropriate 1. Dowell SF, Editor. Principals of judicious use of antimicrobial agents for children’s upper respiratory infections. Pediatrics. Vol 1. January 1998 Supplement. 2. American Academy of Pediatrics and American Academy of Family Physicians, Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics 2004;113:1451-1. CAREFUL ANTIBIOTIC USE Make promoting appropriate antibiotic use part of your routine clinical practice PRACTICE TIPS When parents ask for antibiotics to treat viral infections: Create an office environment to promote the reduction in antibiotic use. ■ Explain that unnecessary antibiotics can be harmful. ■ Talk about antibiotic use at 4 and 12 month well child visits. Tell parents that based on the latest evidence, unnecessary antibiotics CAN be harmful, by promoting resistant organisms in their child and the community. ■ Share the facts. Explain that bacterial infections can be cured by antibiotics, but viral infections never are. Explain that treating viral infections with antibiotics to prevent bacterial infections does not work. ■ Build cooperation and trust. Convey a sense of partnership and don’t dismiss the illness as “only a viral infection”. ■ Encourage active management of the illness. Explicitly plan treatment of symptoms with parents. Describe the expected normal time course of the illness and tell parents to come back if the symptoms persist or worsen. ■ Be confident with the recommendation to use alternative treatments. Prescribe analgesics and decongestants, if appropriate. Emphasize the importance of adequate nutrition and hydration. Consider providing “care packages” with nonantibiotic therapies. The AAP Guidelines for Health Supervision III (1997) now include counseling on antibiotic use as an integral part of well-child care. ■ Start the educational process in the waiting room. Videotapes, posters, and other materials are available. (www.cdc.gov/ncidod/dbmd/antibioticresistance) ■ Involve office personnel in the educational process. Reenforcement of provider messages by office staff can be a powerful adjunct to change patient attitudes. ■ Use the CDC/AAP pamphlets and principles to support your treatment decisions. Provide information to help parents understand when the risks of using antibiotics outweigh the benefits. A GUIDE FOR PARENTS QUESTIONS AND ANSWERS Runny Nose (with green or yellow mucus) Y our child has a runny nose. This is a normal part of what happens during the common cold and as it gets better. Here are some facts about colds and runny noses. What causes a runny nose during a cold? When germs that cause colds first infect the nose and sinuses, the nose makes clear mucus. This helps wash the germs from the nose and sinuses. After two or three days, the body’s immune cells fight back, changing the mucus to a white or yellow color. As the bacteria that live in the nose grow back, they may also be found in the mucus, which changes the mucus to a greenish color. This is normal and does not mean your child needs an antibiotic. Are antibiotics ever needed for a runny nose? Antibiotics are needed only if your healthcare provider tells you that your child has sinusitis. Your child’s healthcare provider may prescribe other medicine or give you tips to help with a cold’s other symptoms like fever and cough, but antibiotics are not needed to treat the runny nose. Why not try antibiotics now? What should I do? • T he best treatment is to wait and watch your child. Runny nose, cough, and symptoms like fever, headache, and muscle aches may be bothersome, but antibiotics will not make them go away any faster. • S ome people find that using a cool mist vaporizer or saltwater nose drops makes their child feel better. Taking antibiotics when they are not needed can be harmful. Each time people take antibiotics, they are more likely to carry resistant germs in their noses and throats. These resistant germs cannot be killed by common antibiotics. Your child may need more costly antibiotics, antibiotics given by a needle, or may even need to be in the hospital to get antibiotics. Since a runny nose almost always gets better on its own, it is better to wait and take antibiotics only when they are needed. 1-800-CDC-INFO www.cdc.gov/getsmart GUÍA PARA PADRES PREGUNTAS Y RESPUESTAS Goteo nasal (con mucosidad verde o amarilla) u hijo tiene un goteo nasal. Esto es normal durante el resfriado común y cuando comienza a curarse. A continuación se presentan algunos datos sobre los resfriados y el goteo nasal. S ¿Qué causa el goteo nasal durante un resfriado? Cuando los gérmenes que provocan el resfriado infectan primero la nariz y los senos nasales, la nariz produce una mucosidad transparente. Esto ayuda a limpiar la nariz y los senos nasales de gérmenes. Después de dos o tres días, las células inmunológicas del cuerpo se defienden y el color de la mucosidad se vuelve blanco o amarillo. A medida que las bacterias que viven en la nariz vuelven a proliferar, también se encuentran en la mucosidad y esto varía su color a un tono verdoso. Esto es normal y no significa que su hijo necesite antibióticos. ¿Es posible que se necesiten antibióticos para tratar el goteo nasal? Los antibióticos se necesitan solamente si su médico dice que su hijo tiene sinusitis. El médico de su hijo puede recetar otros medicamentos o aconsejarle acerca de cómo tratar los demás síntomas del resfriado como la fiebre y la tos, pero no se necesitan antibióticos para tratar el goteo nasal. ¿Por qué no probamos con los antibióticos ahora? ¿Qué debo hacer? • El mejor tratamiento es esperar y observar a su hijo. El goteo nasal, la tos y los síntomas como fiebre, dolor de cabeza y dolor muscular pueden ser molestos, pero los antibióticos no los harán desaparecer más rápido. • Algunas personas creen que utilizar un vaporizador de vapor frío o gotas de agua salada para la nariz hace que sus niños se sientan mejor. Tomar antibióticos cuando no es necesario puede resultar perjudicial. Cada vez que una persona toma antibióticos, los gérmenes dentro de la nariz y de la garganta tienen mayor probabilidad de volverse resistentes. Estos gérmenes resistentes no se pueden eliminar con antibióticos comunes. Su hijo podría necesitar antibióticos más costosos, antibióticos inyectables o incluso ser hospitalizado para obtener los antibióticos. Dado que el goteo nasal casi siempre se resuelve solo, es mejor esperar y tomar antibióticos solamente cuando se necesitan. www.cdc.gov/antibioticos
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