J Am Med Inform Assoc - Impact of a clinical decision support system on antibiotic prescribing for acute respiratory infections in primary care: quasi-experimental trial.

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Resumo

JECTIVE: 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.

Resumo Limpo

jectiv assess effect clinic decis support system cdss integr electron health record ehr antibiot prescrib acut respiratori infect ari primari caremateri method quasiexperiment design nine intervent practic control practic practic partner research network network practic use ehr practic partner nine intervent practic locat nine us state design includ month baselin data collect period octob decemb introduct intervent month followup januari march main outcom measur prescrib antibiot ari episod antibiot inappropri prescrib broadspectrum antibiot ari episodesresult adult patient prescrib antibiot ari episod antibiot inappropri declin among intervent practic control practic p howev among adult cdss intervent improv prescrib broadspectrum antibiot declin among intervent practic versus increas control practic p similar effect broadspectrum antibiot prescrib found pediatr patient declin among intervent practic versus increas control practic pconclus cdss embed ehr modest effect chang prescrib adult antibiot inappropri substanti impact chang overal prescrib broadspectrum antibiot among pediatr adult patient

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