Clinical and economic outcomes of an ambulatory urinary tract infection disease management program

Abstract

Objective: To evaluate the effectiveness of a urinary tract infection disease 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 introduced an antibiotic treatment guideline designed to change the antibiotic prescribing practices of community physicians. The study intervention was the promotion of a treatment guideline through mailings and face-to-face interventions by 2 disease management specialists. A relational database was created to measure changes in healthcare resources, use of antibiotics, and health event profiles.

Results: The study demonstrated that prescribing patterns could be modified through treatment guideline distribution and face-to-face discussions. The study also found similar success rates across a range of antibiotics. Average health event costs decreased by 36% for kidney infections (P = .696) and by 7% for bladder infections (P < .05) after the treatment guideline was implemented; however, when controlling for patient age, sex, and comorbidities, the econometric model did not find a reduction in health event costs for either kidney or bladder infections. Fluoroquinolones were a cost driver compared with other 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 initial antibiotic treatment. In addition, it is recommended that future costs and outcomes be assessed after changes are made to the treatment guideline.