Clinical decision support cuts down antibiotics misuse

Using an electronic health record's clinical decision support (CDS) system can "substantially" affect the prescribing patterns of antibiotics by primary care practices, according to a new study published in the Journal of the American Medical Informatics Association.

The researchers, from the Medical University of South Carolina, studied 70 adult and pediatric primary care practices in nine states, all using the same EHR system. Nine of the practices were intervention practices using the CDS system; the remaining 61 were control practices. The purpose of the study was to determine if the initiation and daily use of a CDS system for the diagnosis and management of acute respiratory tract infections, which would incorporate diagnosis and treatment information as well as delayed prescription strategies for these infections, would have an impact on the prescribing of antibiotics for these conditions.

The researchers found that using a CDS system had a significant impact on the prescribing rate of antibiotics.  The rate of prescribing broad spectrum antibiotics for adults treated by the practices using the CDS declined 16.6 percent compared to an increase of 1.1 percent in the control practices. The decline was even greater for practices treating pediatric patients; those using CDS saw a decline of 19.7 percent versus the control practices, which experienced an increase of 0.9 percent.

The intervention practices also saw a decline of prescribing of antibiotics in acute respiratory infection episodes where antibiotics were inappropriate (negative-0.6 percent), compared to the control practices, which experienced an increase of 4.2 percent.  

Other studies have found that overprescribing of antibiotics and prescribing of them when not clinically indicated is of limited benefit and can carry risks. It's also costly and a waste of resources. Unfortunately often patients clamor for a prescription simply because they are unaware that the drug doesn't help cure many respiratory infections, according to NIH research.

To learn more:
- here's the abstract
- read the antibiotics study
- read the NIH study

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