Cold and flu season is here, and with it comes an increase in patients with respiratory infections ranging from the common cold to respiratory syncytial virus (RSV). These illnesses, which share similar risk factors and symptoms, cannot be effectively treated with antibiotics. That’s why it’s key to prescribe appropriate antibiotics and educate patients about preventing the spread of illness – during the winter months and year-round.

Antibiotic resistance leads to increased morbidity and mortality

It is among the greatest health threats today and can lead to serious health conditions that are harder to treat. The most important modifiable risk factor for antibiotic resistance, according to the Centers for Disease Control and Prevention (CDC), is the inappropriate prescribing and use of antibiotics. Research shows that at least 30 percent of outpatient antibiotic prescribing is unnecessary.¹

Appropriate Treatment for Upper Respiratory Infection (URI) measure

This Healthcare Effectiveness Data and Information Set (HEDIS^®)² measure looks at the percentage of episodes in patients three months 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) (a brand new HEDIS measure).3

Partnering to reduce inappropriate antibiotic prescriptions and improve HEDIS scores

The Cigna Healthcare^SM 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 an improvement in prescribing practices. Based on the success of the pilot, it was expanded to include 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

When antibiotics are not needed (e.g., for a virus), educate patients about symptom management and potential harms (tailored), and offer educational materials.

Provider and patient resources

Encourage your patients with Cigna Healthcare plans to ask questions about prescription medications  by calling the toll-free phone number on the back of their Cigna Healthcare 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 those listed below.

• 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. 11 November 2016. Retrieved from https://www.cdc.gov/antibiotic-use/hcp/core-elements/outpatient-antibiotic-stewardship.html.
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. Retrieved from https://www.ncqa.org/blog/expanding-what-we-know-about-smart-use-of-antibiotics.