 |
|
Clinical Decision Support and Appropriateness of Antimicrobial Prescribing
A Randomized Trial
Matthew H. Samore, MD;
Kim Bateman, MD;
Stephen C. Alder, PhD;
Elizabeth Hannah, DVM;
Sharon Donnelly, MS;
Gregory J. Stoddard, MPH;
Bassam Haddadin, MPH;
Michael A. Rubin, MD, PhD;
Jacquelyn Williamson, MS;
Barry Stults, MD;
Randall Rupper, MD, MPH;
Kurt Stevenson, MD, MPH
JAMA. 2005;294:2305-2314.
Context The impact of clinical decision support systems (CDSS) on antimicrobial prescribing in ambulatory settings has not previously been evaluated.
Objective To measure the added value of CDSS when coupled with a community intervention to reduce inappropriate prescribing of antimicrobial drugs for acute respiratory tract infections.
Design, Participants and Setting Cluster randomized trial that included 407 460 inhabitants and 334 primary care clinicians in 12 rural communities in Utah and Idaho (6 with 1 shared characteristic and 6 with another), and a third group of 6 communities that served as nonstudy controls. The preintervention period was January to December 2001 and the postintervention period was January 2002 to September 2003. Acute respiratory tract infection diagnoses were classified into groups based on indication for antimicrobial use. Multilevel regression methods were applied to account for the clustered design.
Intervention Six communities received a community intervention alone and 6 communities received community intervention plus CDSS that were targeted toward primary care clinicians. The CDSS comprised decision support tools on paper and a handheld computer to guide diagnosis and management of acute respiratory tract infection.
Main Outcome Measure Community-wide antimicrobial usage was assessed using retail pharmacy data. Diagnosis-specific antimicrobial use was compared by chart review.
Results Within CDSS communities, 71% of primary care clinicians participated in the use of CDSS. The prescribing rate decreased from 84.1 to 75.3 per 100 person-years in the CDSS arm vs 84.3 to 85.2 in community intervention alone, and remained stable in the other communities (P = .03). A total of 13 081 acute respiratory tract infection visits were abstracted. The relative decrease in antimicrobial prescribing for visits in the antibiotics "never-indicated" category during the post-intervention period was 32% in CDSS communities and 5% in community intervention-alone communities (P = .03). Use of macrolides decreased significantly in CDSS communities but not in community intervention–alone communities.
Conclusion CDSS implemented in rural primary care settings reduced overall antimicrobial use and improved appropriateness of antimicrobial selection for acute respiratory tract infections.
Trial Registration ClinicalTrials.gov Identifier: NCT00235703.
Author Affiliations: VA Salt Lake City Health Care System (Drs Samore and Rupper); Department of Internal Medicine, University of Utah, Salt Lake City (Drs Samore, Bateman, Alder, Rubin, Stults, Rupper, and Stevenson, Mssrs Stoddard, Haddadin, and Ms Williamson); HealthInsight, Salt Lake City (Dr Bateman and Ms Donnelly); and Qualis Health, Boise, Idaho (Drs Hannah and Stevenson). Dr Stevenson is now with the Ohio State University College of Medicine, Columbus.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial
Cals et al.
BMJ 2009;338:b1374-b1374.
ABSTRACT
| FULL TEXT
Effect of guideline based computerised decision support on decision making of multidisciplinary teams: cluster randomised trial in cardiac rehabilitation
Goud et al.
BMJ 2009;338:b1440-b1440.
ABSTRACT
| FULL TEXT
Impact of a 16-Community Trial to Promote Judicious Antibiotic Use in Massachusetts
Finkelstein et al.
Pediatrics 2008;121:e15-e23.
ABSTRACT
| FULL TEXT
Quality of Care in the Retail Health Care Setting Using National Clinical Guidelines for Acute Pharyngitis
Woodburn et al.
American Journal of Medical Quality 2007;22:457-462.
ABSTRACT
Reducing antibiotic prescriptions for acute cough by motivating GPs to change their attitudes to communication and empowering patients: a cluster-randomized intervention study
Altiner et al.
J Antimicrob Chemother 2007;60:638-644.
ABSTRACT
| FULL TEXT
Don't wear me out--the public's knowledge of and attitudes to antibiotic use
McNulty et al.
J Antimicrob Chemother 2007;59:727-738.
ABSTRACT
| FULL TEXT
Use of a Personal Digital Assistant for Managing Antibiotic Prescribing for Outpatient Respiratory Tract Infections in Rural Communities
Rubin et al.
J. Am. Med. Inform. Assoc. 2006;13:627-634.
ABSTRACT
| FULL TEXT
A handheld computer smoking intervention tool and its effects on physician smoking cessation counseling.
Strayer et al.
J Am Board Fam Med 2006;19:350-357.
ABSTRACT
| FULL TEXT
Impact of a Computerized Clinical Decision Support System on Reducing Inappropriate Antimicrobial Use: A Randomized Controlled Trial
McGregor et al.
J. Am. Med. Inform. Assoc. 2006;13:378-384.
ABSTRACT
| FULL TEXT
Additional articles abstracted in ACP Journal Club
Evid. Based Med. 2006;11:94-94.
FULL TEXT
Clinical decision support systems and antibiotic prescribing.
van der Wouden and Kuyvenhoven
JAMA 2006;295:1771-1771.
FULL TEXT
Evidently...
Lehman
Evid. Based Med. 2006;11:6-6.
FULL TEXT
Reducing Inappropriate Antibiotic Use: Possible, But Expensive
JWatch General 2005;2005:3-3.
FULL TEXT
Appropriate Use of Antimicrobial Drugs: A Better Prescription Is Needed
Weber
JAMA 2005;294:2354-2356.
FULL TEXT
|
