Impact of a clinical decision support system on antibiotic prescribing for acute respiratory infections in primary care: quasi-experimental trial
- 1Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- 2Division of Biostatistics and Epidemiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Correspondence to Dr Arch Mainous III, Department of Family Medicine, Medical University of South Carolina, 295 Calhoun Street, Charleston, SC 29425 USA;
Contributors AM, CAL and PJN contributed to the conception and design of the study and participated in the analysis of data. All authors had access to the data and participated in drafting the article or revising it critically for important intellectual content. All authors gave final approval of the version to be published.
- Received 17 November 2011
- Accepted 8 June 2012
- Published Online First 3 July 2012
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.
Funding This study was funded by the Agency for Healthcare Research and Quality, Contract No HHSA290200710015I.
Competing interests None.
Ethics approval Ethics approval was obtained from the Medical University of South Carolina Institutional Review Board for this research study.
Provenance and peer review Not commissioned; externally peer reviewed.