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Multicenter Study
. 2013 Jun;28(6):810-6.
doi: 10.1007/s11606-012-2267-2. Epub 2012 Nov 2.

Use of an electronic health record clinical decision support tool to improve antibiotic prescribing for acute respiratory infections: the ABX-TRIP study

Cara B Litvin  1 , Steven M Ornstein, Andrea M Wessell, Lynne S Nemeth, Paul J Nietert
Affiliations
Multicenter Study

Use of an electronic health record clinical decision support tool to improve antibiotic prescribing for acute respiratory infections: the ABX-TRIP study

Cara B Litvin et al. J Gen Intern Med. 2013 Jun.

Abstract

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.

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Figures

Figure 1.
Figure 1.
Clinical decision support system (CDSS) use by month (January 1, 2010–March 31, 2012).
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References

    1. Grijalva CG, Nuorti JP, Griffin MR. Antibiotic prescription rates for acute respiratory tract infections in US ambulatory settings. JAMA. 2009;302(7):758–66. - PMC - PubMed
    1. Linder JA. Editorial commentary: antibiotics for treatment of acute respiratory tract infections: decreasing benefit, increasing risk, and the irrelevance of antimicrobial resistance. Clin Infect Dis. 2008;47(6):744–6. doi: 10.1086/591149. - DOI - PubMed
    1. Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010;340:c2096. doi: 10.1136/bmj.c2096. - DOI - PubMed
    1. Besser RE. Antimicrobial prescribing in the United States: good news, bad news. Ann Intern Med. 2003;138(7):605–6. - PubMed
    1. Linder JA, Schnipper JL, Tsurikova R, Volk LA, Middleton B. Self-reported familiarity with acute respiratory infection guidelines and antibiotic prescribing in primary care. Int J Qual Health Care. 2010;22(6):469–75. doi: 10.1093/intqhc/mzq052. - DOI - PMC - PubMed

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