CWP Overview

Hello, and welcome to appropriate testing for pharyngitis.

Here are the objectives we will review. The appropriate testing for pharyngitis. The acronym for this HEDIS measure is CWP.

We will discuss pharyngitis and symptoms, review diagnosis and testing, and lastly suggested best practices.

Appropriate testing for pharyngitis, CWP.

Before we begin, let's review some important definitions.

The first one is intake period. This is a 12 month window that begins on July 1st of the year prior to the measurement year and ends on June 30th on the measurement year. This captures the eligible episodes of treatment.

Episode date, the date of service for any outpatient telephone observation or ED visit, e-visit or virtual check in, during the intake period with a diagnosis of pharyngitis.

The CWP HEDIS measure assesses the percentage of episodes for members 3 years of age and older with the diagnosis of pharyngitis, dispensed an antibiotic, and received a group A Streptococcus test with the episode.

A higher rate represents better performance, such as appropriate testing, compliance is met if patient received a group A Streptococcus test during the episode period, which is a 7 day period spanning from 3 days prior to the episode to 3 days after the episode. Compliance is determined independently for each eligible episode occurring in a measurement year. This measure considers all eligible episodes.

So a patient can count more than once toward performance for a measurement year.

Members can either be seen in an outpatient setting, telephone, online assessment, observation or ED visit. Keep in mind that observation or ED visits that result in inpatient stays are not included in the measure.

As per the CDC, the use of a recommended antibiotic regimen to treat group A strep pharyngitis shortens the duration of symptoms, reduces the likelihood of transmission to family members, classmates and other close contacts, prevents the development of complications to include acute rheumatic fever and kidney problems that can occur if an infection remains untreated as mentioned previously.

As per the CDC when left untreated, the symptoms of group A strep pharyngitis are usually self-limited patients regardless of age who have a positive RADT or throat culture, need antibiotics. Clinicians should not treat viral pharyngitis with antibiotics.

The misuse of antibiotics can have adverse clinical outcomes, such as Cdiff infections and antibiotic resistance, and this is where antibiotics can no longer cure bacterial infections.

Both viral and bacterial forms of pharyngitis are contagious according to the Centers for Disease Control and prevention. A person can help prevent spreading strep throat to other people by staying home until they are no longer having a fever and have been taking antibiotics for at least 24 hours.

Pharyngitis and Symptoms.

As per John Hopkins Medicine, pharyngitis, commonly known as a sore throat, is an inflammation of the pharynx resulting in a sore throat. Thus pharyngitis is a symptom rather than a condition.

It is usually caused by viral and or bacterial infections, such as the common cold and flu or by infection with the Streptococcus bacteria.

Pharyngitis can also occur with mononucleosis also known as mono, a viral infection. Per NCQA, pharyngitis is a leading cause of outpatient care.

As per the CDC, clinicians need to use either a rapid antigen detection test also known as an RADT or throat culture to confirm group A strep pharyngitis. RADTs have high specificity for group A strep, but varying sensitivities when compared to throat culture.

Throat culture is the gold standard diagnostic test.

Other symptoms may be present, depending on the cause, these include fatigue, malaise, swollen lymph nodes and skin rash, especially with the flu or other viral infections.

Diagnosis and Testing.

According to the CDC, the differential diagnosis of acute pharyngitis includes multiple viral and bacterial pathogens. Viruses are the most common cause of pharyngitis in all age groups.

Experts estimate that group A strep, the most common bacterial cause, causes 20 to 30% of pharyngitis episodes in children. In comparison to approximately 5 to 15% of infections in adults. Patients with clear viral symptoms do not need testing for group A strep.

However, clinicians cannot use clinical examination to tell the difference between viral and group A strep pharyngitis. In the absence of viral symptoms, clinicians need to use either a rapid antigen detection test or throat culture to confirm group a strep pharyngitis.

Remember RADT have high specificity for group A strep, but varying sensitivities when compared to throat culture. Throat culture is the gold standard diagnostic tests.

The treatment depends on the cause. Viral pharyngitis goes away on its own with salt water gargles, pain relievers and extra fluids to help alleviate the symptoms.

Bacterial pharyngitis is treated with antibiotics and fungal pharyngitis with antifungal medication.

Prompt antibiotic therapy is needed for strep throat because untreated, it can sometimes cause kidney problems and rheumatic fever, which can damage the heart valve.

A full assessment in the clinic will guide treatment for other causes.

Fungal pharyngitis occurs in the setting of immunosuppression or chronic steroids and antibiotic use and is not as common as other types.

Here is a list of the CWP antibiotic medications.

Best practices for CWP, educate members and or guardian if they visited the ED or urgent care, they should notify the provider within 24 hours. Develop an office policy for use of emergency room and or urgent care visits.

Request members, and or guardians, contact the PCP prior to visits to ED or urgent care center. Test for group A Streptococcus to confirm diagnosis before prescribing antibiotics. Educate on the importance of finishing the entire course of antibiotics as prescribed, even if the patient starts to feel better. Provide tips for managing viral infections and their symptoms such as over the counter medications, rest, fluids, cool mist vaporizers. Never treat red throats empirically as they are viral.

Even in children with long history of strep, educate that an antibiotic is not necessary for viral infections if rapid strep test and or throat culture is negative.

In conclusion, there are a range of symptoms that can mirror cold and flu symptoms. Proper testing and treatment prevents the spread of sickness while reducing the unnecessary use of antibiotics.

Antibiotics should only be used for bacterial infections.

Treat bacterial pharyngitis immediately to prevent serious life threatening complications.

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