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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: Dr Samore and colleagues¹ described the results of an effort to improve appropriateness of antibiotic use with a clinical decision support system (CDSS). We have some concerns whether the difference in effect between the CDSS group and the community intervention group can be ascribed to the decision support that was offered.

Table 2 indicates that several components of the community intervention differed between the 2 groups, favoring the CDSS group. Although the groups were roughly similar in population size, 83% more posters and 42% more brochures were distributed in the communities in the CDSS group. Household mailings and self-care guides distributed at health fairs also favored the CDSS group by 23% and 26%, respectively. The difference in intensity of the community intervention is an alternate explanation for the difference in effect between the 2 groups.

A 10% reduction of prescribing rates seems to be the best achievable . . . [Full Text of this Article]

Johannes C. van der Wouden, PhD
j.vanderwouden@erasmusmc.nl
Department of General Practice
Erasmus MC
Rotterdam, the Netherlands

Marijke M. Kuyvenhoven, PhD
Julius Center for Health Sciences and Primary Care
University Medical Center Utrecht
Utrecht, the Netherlands

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