CWP Overview

Results and Recognition Programs, Appropriate Testing for Pharyngitis.

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

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. 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, 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 a diagnosis of pharyngitis, was dispensed an antibiotic, and received a group A streptococcus test for the episode.

A higher rate represents better performance.

Compliance is met if the patient received a group A strep 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. 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, including acute rheumatic fever and kidney problems, that can occur if an infection remains untreated as mentioned previously.

When left untreated, the symptoms of group A strep pharyngitis are usually self-limited.

Patients, regardless of age, who have a positive Rapid Antigen Detection Test, also known as an RADT, or throat culture, need antibiotics.

Clinicians should not treat viral pharyngitis with antibiotics.

The misuse of antibiotics can cause adverse clinical outcomes, such as CDiff infections and antibiotic resistance.

Both viral and bacterial forms of pharyngitis are contagious.

A person can help prevent spreading strep throat to other people by staying home until they no longer have a fever or have been taking antibiotics for at least 24 hours.

Pharyngitis and Symptoms.

As per Johns Hopkins Medicine, pharyngitis, commonly known as sore throat, is an inflammation of the pharynx. So, in essence, 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 infections with the streptococcus bacteria.

Pharyngitis can also occur with mononucleosis, also known as Mono, a viral infection.

As per NCQA, pharyngitis is a leading cause of outpatient care.

As per the CDC, clinicians need to use either a rapid antigen test or a 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.

What are symptoms of pharyngitis?

Sore, dry, scratchy throat. Pain when swallowing or speaking. Runny nose or nasal congestion.

Fever, headache, joint, muscle or ear pain. 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.

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 medications.

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

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

Fungal pharyngitis occurs in the setting of immunosuppression or chronic steroid and antibiotic use.

It is not as common as the other types.

Here is a list of the CWP antibiotic medications.

Best practices for CWP.

Educate members and/or guardians.

If they visit an 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 or guardians contact the PCP prior to visits to an 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 a long history of strep.

Educate that an antibiotic is not necessary for viral infections if rapid strep test and/or throat culture is negative.

Conclusion. There are a range of symptoms that can mirror cold or flu symptoms.

Proper testing and treatment prevents the spread of sickness, while reducing 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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