Documentation-based clinical decision support to improve antibiotic prescribing for acute respiratory infections in primary care: A cluster randomised controlled trial

Jeffrey A. Linder, Jeffrey L. Schnipper, Ruslana Tsurikova, Tony Yu, Lynn A. Volk, Andrea J. Melnikas, Matvey B. Palchuk, Maya Olsha-Yehiav, Blackford Middleton

Research output: Contribution to journalArticlepeer-review

57 Scopus citations

Abstract

Background and objective Clinical guidelines discourage antibiotic prescribing for many acute respiratory infections (ARIs), especially for non- antibiotic appropriate diagnoses. Electronic health record (EHR)-based clinical decision support has the potential to improve antibiotic prescribing for ARIs. Methods We randomly assigned 27 primary care clinics to receive an EHR-integrated, documentation- based clinical decision support system for the care of patients with ARIs - the ARI Smart Form - orto offer usual care. The primary outcome was the antibiotic prescribing rate for ARIs in an intent- to-intervene analysis based on administrative diagnoses. Results During the intervention period, patients made 21961 ARI visits to study clinics. Intervention clinicians used the ARI Smart Form in 6% of 11 954 ARI visits. The antibiotic prescribing rate in the intervention clinics was 39% versus 43% in the control clinics (odds ratio (OR), 0.8; 95% confidence interval (CI), 0.6-1.2, adjusted for clustering by clinic). For antibiotic appropriate ARI diagnoses, the antibiotic prescribing rate was 54% in the intervention clinics and 59% in the control clinics (OR, 0.8; 95% CI, 0.5-1.3). For non-antibiotic appropriate diagnoses, the antibiotic prescribing rate was 32% in the intervention clinics and 34% in the control clinics (OR, 0.9; 95% CI, 0.6-1.4). When the ARI Smart Form was used, based on diagnoses entered on the form, the antibiotic prescribing rate was 49% overall, 88% for antibiotic appropriate diagnoses and 27% for non-antibiotic appropriate diagnoses. In an as-used analysis, the ARI Smart Form was associated with a lower antibiotic prescribing rate for acute bronchitis (OR, 0.5; 95% CI, 0.3-0.8). Conclusions The ARI Smart Form neither reduced overall antibiotic prescribing nor significantly improved the appropriateness of antibiotic prescribing for ARIs, but it was not widely used. When used, the ARI Smart Form may improve diagnostic accuracy compared to administrative diagnoses and may reduce antibiotic prescribing for certain diagnoses.

Original languageEnglish (US)
Pages (from-to)231-240
Number of pages10
JournalInformatics in Primary Care
Volume17
Issue number4
DOIs
StatePublished - 2009

Keywords

  • Antibacterial agents
  • Clinical decision support systems
  • Computerised medical record systems
  • Respiratory tract infections

ASJC Scopus subject areas

  • Leadership and Management
  • Health Informatics
  • Family Practice

Fingerprint Dive into the research topics of 'Documentation-based clinical decision support to improve antibiotic prescribing for acute respiratory infections in primary care: A cluster randomised controlled trial'. Together they form a unique fingerprint.

Cite this