Research Activities, September 2013
Clinical decision support system can reduce inappropriate prescribing of antibiotics for acute respiratory infections
Health Information Technology
Antibiotics prescribed for acute respiratory tract infection (ARI) most likely due to viruses (not treatable by antibiotics) accounts for more than half of all antibiotics prescribed in primary care, despite recommendations against it. Unfortunately, this practice encourages the development of drug-resistant bacteria. A new study indicates that incorporating clinical decision support software (CDSS) into a primary care practice’s electronic health record (EHR) system can significantly reduce inappropriate prescribing compared to practices without CDSS.
The researchers tested the impact of incorporating the CDSS on treatment of ARIs into the intervention practices’ EHRs (totaling 27 physicians, 6 nurse practitioners, and 6 physician assistants). They compared quarterly data on the occurrence and treatment of ARIs with a group of primary care control practices. Inappropriate prescribing of antibiotics among intervention practices at the end of the study period was 0.6 percent below that for the 3-month baseline period versus 4.2 percent above baseline for the control practices. However, this trend was not seen for pediatric patients.
The researchers also compared the impact of the intervention on prescription of broad-spectrum antibiotics (that treat a broad range of bacteria) for ARIs. The use of broad-spectrum antibiotics fell significantly more from baseline among the intervention practices (down 16.6 percent for adults and 19.7 percent for children) compared to the control practices (up 1.2 percent for adults and up 0.9 percent for children).
The findings were based on analysis of data from primary care practices belonging to the Practice Partner Research Network, a group of practices using the same commercial EHR (each in a different State) and 61 control practices. The study was funded by AHRQ (Contract No. 290-07-10015).
More details are in "Impact of a clinical decision support system on antibiotic prescribing for acute respiratory infections in primary care: Quasi-experimental trial," by Arch G. Mainous III, Ph.D., Carol A. Lambourne, Ph.D., and Paul J. Nietert, Ph.D., in the March/April 2013 Journal of the American Medical Informatics Association 20(2), pp. 317-324.