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Controlled Clinical Trial
. 2013 Mar-Apr;20(2):317-24.
doi: 10.1136/amiajnl-2011-000701. Epub 2012 Jul 3.

Impact of a clinical decision support system on antibiotic prescribing for acute respiratory infections in primary care: quasi-experimental trial

Arch G Mainous 3rd  1 , Carol A Lambourne, Paul J Nietert
Affiliations
Controlled Clinical Trial

Impact of a clinical decision support system on antibiotic prescribing for acute respiratory infections in primary care: quasi-experimental trial

Arch G Mainous 3rd et al. J Am Med Inform Assoc. 2013 Mar-Apr.

Abstract

Objective: To assess the effect of a clinical decision support system (CDSS) integrated into an electronic health record (EHR) on antibiotic prescribing for acute respiratory infections (ARIs) in primary care.

Materials and methods: Quasi-experimental design with nine intervention practices and 61 control practices in the Practice Partner Research Network, a network of practices which all use the same EHR (Practice Partner). The nine intervention practices were located in nine US states. The design included a 3-month baseline data collection period (October through December 2009) before the introduction of the intervention and 15 months of follow-up (January 2010 through March 2011). The main outcome measures were the prescribing of antibiotics in ARI episodes for which antibiotics are inappropriate and prescribing of broad-spectrum antibiotics in all ARI episodes.

Results: In adult patients, prescribing of antibiotics in ARI episodes where antibiotics are inappropriate declined more (-0.6%) among intervention practices than in control practices (+4.2%) (p=0.03). However, among adults, the CDSS intervention improved prescribing of broad-spectrum antibiotics, with a decline of 16.6% among intervention practices versus an increase of 1.1% in control practices (p<0.0001). A similar effect on broad-spectrum antibiotic prescribing was found in pediatric patients with a decline of 19.7% among intervention practices versus an increase of 0.9% in control practices (p<0.0001).

Conclusions: A CDSS embedded in an EHR had a modest effect in changing prescribing for adults where antibiotics were inappropriate but had a substantial impact on changing the overall prescribing of broad-spectrum antibiotics among pediatric and adult patients.

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Conflict of interest statement

Competing interests: None.

Figures

Figure 1
Figure 1
Screen shot of the sequence of the clinical decision support tool within the electronic health record for acute respiratory infection.
Figure 2
Figure 2
Comparisons of intervention and control practices' inappropriate prescribing over time in adult patients (A) and pediatric patients (B) (weighted means and 95% CIs).
Figure 3
Figure 3
Comparisons of intervention and control practices' use of broad-spectrum antibiotics over time in adult patients (A) pediatric patients (B) (weighted means and 95% CIs).
See this image and copyright information in PMC

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