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In Reply: Drs van der Wouden and Kuyvenhoven offer the alternative hypothesis that the effects on antimicrobial prescribing that were observed in our study were secondary to differences in implementation of the community intervention rather than a consequence of clinical decision support system (CDSS) use. We believe that this explanation is not supported by the study results. Communities randomized to the community intervention alone arm did not demonstrate any change in total antimicrobial drug use or drug selection during the intervention compared with baseline. The marked decrease in macrolide prescriptions within CDSS communities, in line with the recommendations of the CDSS tools, is also much more compatible with a physician-based effect.

Our strategy for implementation of community intervention was the same across both study arms. In the context of a complex field intervention study, it is not surprising that the exact numbers of distributed educational materials varied across communities. Materials . . . [Full Text of this Article]

Matthew H. Samore, MD
matthew.samore@hsc.utah.edu

Gregory J. Stoddard, MPH; Stephen C. Alder, PhD; Bassam Haddadin, MPH; Michael A. Rubin, MD, PhD; Kim Bateman, MD
Department of Internal Medicine
University of Utah School of Medicine
Salt Lake City

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