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Use of an Electronic Health Record Clinical Decision Support Tool to Improve Antibiotic Prescribing for Acute Respiratory Infections: The ABX-TRIP Study

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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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Acknowlegdements

Funder

This study was conducted under contract by the Agency for Healthcare Research and Quality, Contract No. HHSA290200710015I. Dr. Litvin is supported by the Agency for Healthcare Research and Quality Grant # K08HS018984. The funding agency had no role in the study design; in collection, analysis, and interpretation of data; in writing of the report; or in the decision to submit the paper for publication.

Prior Presentations

Preliminary results from this study were presented at the Society of General Internal Medicine Annual Meeting on May 11, 2012.

Conflict of Interest

PPRNet/MUSC has a research and development contract with McKesson, and Dr. Ornstein is the principal investigator. Drs. Ornstein and Wessell receive salary support from the contract. Drs. Litvin, Nietert and Nemeth declare that they do not have any conflicts of interest.

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Authors and Affiliations

  1. Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, Charleston, SC, 29425, USA

    Cara B. Litvin MD, MS

  2. Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA

    Steven M. Ornstein MD & Andrea M. Wessell PharmD

  3. College of Nursing, Medical University of South Carolina, Charleston, SC, USA

    Lynne S. Nemeth RN, PhD

  4. Division of Biostatistics and Epidemiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA

    Paul J. Nietert PhD

Authors
  1. Cara B. Litvin MD, MS
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  2. Steven M. Ornstein MD
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  3. Andrea M. Wessell PharmD
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  4. Lynne S. Nemeth RN, PhD
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  5. Paul J. Nietert PhD
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Corresponding author

Correspondence to Cara B. Litvin MD, MS.

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Litvin, C.B., Ornstein, S.M., Wessell, A.M. et al. Use of an Electronic Health Record Clinical Decision Support Tool to Improve Antibiotic Prescribing for Acute Respiratory Infections: The ABX-TRIP Study. J GEN INTERN MED 28, 810–816 (2013). https://doi.org/10.1007/s11606-012-2267-2

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  • DOI: https://doi.org/10.1007/s11606-012-2267-2

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