BACKGROUND: Antibiotics are often inappropriately prescribed for acute respiratory infections (ARIs). OBJECTIVE: To assess the impact of a clinical decision support system (CDSS) on antibiotic prescribing for ARIs. DESIGN: A two-phase, 27-month demonstration project. SETTING: Nine primary care practices in PPRNet, a practice-based research network whose members use a common electronic health record (EHR). PARTICIPANTS: Thirty-nine providers were included in the project. INTERVENTION: A CDSS was designed as an EHR progress note template. To facilitate CDSS implementation, each practice participated in two to three site visits, sent representatives to two project meetings, and received quarterly performance reports on antibiotic prescribing for ARIs. MAIN OUTCOME MEASURES: 1) Use of antibiotics for inappropriate indications. 2) Use of broad spectrum antibiotics when inappropriate. 3) Use of antibiotics for sinusitis and bronchitis. KEY RESULTS: The CDSS was used 38,592 times during the 27-month intervention; its use was sustained for the study duration. Use of antibiotics for encounters at which diagnoses for which antibiotics are rarely appropriate did not significantly change through the course of the study (estimated 27-month change, 1.57% [95% CI, -5.35%, 8.49%] in adults and -1.89% [95% CI, -9.03%, 5.26%] in children). However, use of broad spectrum antibiotics for ARI encounters improved significantly (estimated 27 month change, -16.30%, [95% CI, -24.81%, -7.79%] in adults and -16.30 [95%CI, -23.29%, -9.31%] in children). Prescribing for bronchitis did not change significantly, but use of broad spectrum antibiotics for sinusitis declined. CONCLUSIONS: This multi-method intervention appears to have had a sustained impact on reducing the use of broad spectrum antibiotics for ARIs. This intervention shows promise for promoting judicious antibiotic use in primary care.
BACKGROUND: Antibiotics are often inappropriately prescribed for acute respiratory infections (ARIs). OBJECTIVE: To assess the impact of a clinical decision support system (CDSS) on antibiotic prescribing for ARIs. DESIGN: A two-phase, 27-month demonstration project. SETTING: Nine primary care practices in PPRNet, a practice-based research network whose members use a common electronic health record (EHR). PARTICIPANTS: Thirty-nine providers were included in the project. INTERVENTION: A CDSS was designed as an EHR progress note template. To facilitate CDSS implementation, each practice participated in two to three site visits, sent representatives to two project meetings, and received quarterly performance reports on antibiotic prescribing for ARIs. MAIN OUTCOME MEASURES: 1) Use of antibiotics for inappropriate indications. 2) Use of broad spectrum antibiotics when inappropriate. 3) Use of antibiotics for sinusitis and bronchitis. KEY RESULTS: The CDSS was used 38,592 times during the 27-month intervention; its use was sustained for the study duration. Use of antibiotics for encounters at which diagnoses for which antibiotics are rarely appropriate did not significantly change through the course of the study (estimated 27-month change, 1.57% [95% CI, -5.35%, 8.49%] in adults and -1.89% [95% CI, -9.03%, 5.26%] in children). However, use of broad spectrum antibiotics for ARI encounters improved significantly (estimated 27 month change, -16.30%, [95% CI, -24.81%, -7.79%] in adults and -16.30 [95%CI, -23.29%, -9.31%] in children). Prescribing for bronchitis did not change significantly, but use of broad spectrum antibiotics for sinusitis declined. CONCLUSIONS: This multi-method intervention appears to have had a sustained impact on reducing the use of broad spectrum antibiotics for ARIs. This intervention shows promise for promoting judicious antibiotic use in primary care.
Authors: Lionel A Mandell; Richard G Wunderink; Antonio Anzueto; John G Bartlett; G Douglas Campbell; Nathan C Dean; Scott F Dowell; Thomas M File; Daniel M Musher; Michael S Niederman; Antonio Torres; Cynthia G Whitney Journal: Clin Infect Dis Date: 2007-03-01 Impact factor: 9.079
Authors: Michael A Rubin; Kim Bateman; Sharon Donnelly; Gregory J Stoddard; Kurt Stevenson; Reed M Gardner; Matthew H Samore Journal: J Am Med Inform Assoc Date: 2006-08-23 Impact factor: 4.497
Authors: Larry C Field; Matthew D McEvoy; Jeremy C Smalley; Carlee A Clark; Michael B McEvoy; Horst Rieke; Paul J Nietert; Cory M Furse Journal: Resuscitation Date: 2013-09-19 Impact factor: 5.262
Authors: Devin Mann; Rachel Hess; Thomas McGinn; Safiya Richardson; Simon Jones; Joseph Palmisano; Sara Kuppin Chokshi; Rebecca Mishuris; Lauren McCullagh; Linda Park; Catherine Dinh-Le; Paul Smith; David Feldstein Journal: J Gen Intern Med Date: 2020-09-01 Impact factor: 5.128
Authors: Randi E Foraker; Bobbie Kite; Marjorie M Kelley; Albert M Lai; Caryn Roth; Marcelo A Lopetegui; Abigail B Shoben; Michael Langan; Nicole L Rutledge; Philip R O Payne Journal: EGEMS (Wash DC) Date: 2015-06-18