With the arrival of cold and flu season, your office will likely see a rise in patients with respiratory infections, which may vary from the common cold to respiratory syncytial virus (RSV). While patients often anticipate receiving an antibiotic, these typically viral illnesses cannot be effectively treated with antibiotics. Therefore, it’s crucial to prescribe antibiotics judiciously and to educate patients on how to care for symptoms and prevent the spread of illness.

Antibiotic resistance contributes to increased illness and mortality

This issue represents one of the most significant health threats today, resulting in serious conditions that are more challenging to treat. According to the U.S. Centers for Disease Control and Prevention (CDC), the primary modifiable risk factor for antibiotic resistance is the inappropriate prescribing and use of antibiotics. Research shows that at least 30 percent of outpatient antibiotic prescribing is unnecessary.¹

HEDIS antibiotic measures

The Healthcare Effectiveness Data and Information Set (HEDIS^®)² is one of the most widely used tools for performance improvement in health care, evaluating areas where improvements can significantly impact individuals’ well-being. HEDIS includes various measures that focus on the appropriate prescribing of antibiotics.

The Appropriate Treatment for Upper Respiratory Infection (URI) HEDIS measure looks at the percentage of episodes in patients three months of age and older with a diagnosis of a URI that did not result in an antibiotic dispensing event. A higher rate indicates an antibiotic was not dispensed, which is considered appropriate treatment since most URIs are viral.

Other HEDIS measures that look at antibiotic appropriateness include:

• Appropriate Testing for Pharyngitis (CWP)
• Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB)
• Antibiotic Utilization for Respiratory Conditions (AXR)³

Partnering to reduce inappropriate antibiotic prescriptions and improve HEDIS scores

The Cigna Healthcare^® Quality team and Market Medical Executives review prescribing patterns among contracted providers to gain a better understanding of trends in antibiotics use, as well as learn about opportunities for patient and provider support and education. In addition to reducing health conditions and complications related to overuse of antibiotics, the goal is to drive better patient outcomes.

In a 2023 pilot program, Cigna Healthcare audited and provided feedback to certain providers in Texas who had a high rate of prescribing antibiotics for nonspecific URIs for patients over three months of age. This outreach resulted in a significant improvement in prescribing practices. Based on the success of the pilot, it was expanded to include additional states with low compliance and all antibiotic appropriateness measures to provide support for prescribing practices.

Best practices for patient education and guidance

According to the CDC, the core elements of effective antibiotic stewardship include commitment, policy and practice, tracking and reporting, and patient education. Some tips to improve prescribing at the practice level are highlighted below:¹

• Commitment: Write and display a public commitment of support of antibiotic stewardship. When displayed in the exam room, it can facilitate patient-provider communications and help set patient expectations.
• Policy and practice: Use clinical practice guidelines, try delayed prescribing practices or watchful waiting (when appropriate), take communication skills training, provide justification and support, and use call centers and hotlines to triage and prevent unnecessary visits (e.g., for colds).
• Tracking and reporting: Self-evaluate antibiotic prescribing practices, encourage continuing education, implement systems, and share performance on quality.
• Patient education: For vaccine preventable viral illnesses such as influenza, Covid and RSV, risks and benefits should be considered.
• Provider and patient resources: Encourage your patients with Cigna Healthcare coverage to ask questions about prescription medications by calling the toll-free phone number on the back of their ID card. They will receive quick answers to their health-related questions that can support you with triage.

In addition, you and your patients can visit the CDC website to view many other educational resources regarding antibiotics prescribing and use, including the following:

• Educational Materials for Healthcare Providers
• Patient Education Resources
• Healthy Habits: Antibiotic Do’s and Don’ts

1   Guillermo V. Sanchez, et al. Core Elements of Outpatient Antibiotic Stewardship. CDC.2026 (under Overview).

2   HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

3   Andy Reynolds. Expanding What We Know About Smart Use of Antibiotics. NCQA. 26 February 2024.