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Decision support during electronic prescription to stem antibiotic overuse for acute respiratory infections: a long-term, quasi-experimental study

BACKGROUND: Interventions to support decision-making can reduce inappropriate antibiotic use for acute respiratory infections (ARI), but they may not be sustainable. The objective of the study is to evaluate the long-term effectiveness of a clinical decision-support system (CDSS) interposed at the t...

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Autores principales: Gifford, Jeneen, Vaeth, Elisabeth, Richards, Katherine, Siddiqui, Tariq, Gill, Christine, Wilson, Lucy, DeLisle, Sylvain
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537944/
https://www.ncbi.nlm.nih.gov/pubmed/28760143
http://dx.doi.org/10.1186/s12879-017-2602-7
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author Gifford, Jeneen
Vaeth, Elisabeth
Richards, Katherine
Siddiqui, Tariq
Gill, Christine
Wilson, Lucy
DeLisle, Sylvain
author_facet Gifford, Jeneen
Vaeth, Elisabeth
Richards, Katherine
Siddiqui, Tariq
Gill, Christine
Wilson, Lucy
DeLisle, Sylvain
author_sort Gifford, Jeneen
collection PubMed
description BACKGROUND: Interventions to support decision-making can reduce inappropriate antibiotic use for acute respiratory infections (ARI), but they may not be sustainable. The objective of the study is to evaluate the long-term effectiveness of a clinical decision-support system (CDSS) interposed at the time of electronic (e-) prescriptions for selected antibiotics. METHODS: This is a retrospective, observational intervention study, conducted within a large, statewide Veterans Affairs health system. Participants are outpatients with an initial visit for ARI. A CDSS was deployed upon e-prescription of selected antibiotics during the study period. From 01/2004 to 05/2006 (pre-withdrawal period), the CDSS targeted azithromycin and the fluoroquinolone gatifloxacin. From 05/2006 to 12/2011 (post-withdrawal period), the CDSS was retained for azithromycin but withdrawn for the fluoroquinolone. A manual record review was conducted to determine concordance of antibiotic prescription with ARI treatment guidelines. RESULTS: Of 1131 included ARI visits, 380 (33.6%) were guideline-concordant. For azithromycin, concordance did not change between the pre- and post-withdrawal periods, and adjusted odds of concordance was 8.8 for the full study period, compared to unrestricted antibiotics. For fluoroquinolones, guideline concordance decreased from 88.6% (39 of 44 visits) to 51.3% (59 of 115 visits), pre- vs. post-withdrawal periods (p < 0.005). The adjusted odds of concordance compared to “All Other Antibiotics” visits decreased from 24.4 (95% CI 9.0–66.3) pre-withdrawal to 5.5 (95% CI 3.5–8.8) post-withdrawal (p = .008). Concordance did not change between those same time periods for antibiotics that were never subjected to the intervention (“All Other Antibiotics”). CONCLUSIONS: A CDSS interposed at the time of e-prescription of selected antibiotics can shift their use toward ARI treatment guidelines, and this effect can be maintained over the long term as long as the CDSS remains in place. Removal of the CDSS after 3.5 years of implementation resulted in a rise in guideline-discordant antibiotic use. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12879-017-2602-7) contains supplementary material, which is available to authorized users.
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spelling pubmed-55379442017-08-04 Decision support during electronic prescription to stem antibiotic overuse for acute respiratory infections: a long-term, quasi-experimental study Gifford, Jeneen Vaeth, Elisabeth Richards, Katherine Siddiqui, Tariq Gill, Christine Wilson, Lucy DeLisle, Sylvain BMC Infect Dis Research Article BACKGROUND: Interventions to support decision-making can reduce inappropriate antibiotic use for acute respiratory infections (ARI), but they may not be sustainable. The objective of the study is to evaluate the long-term effectiveness of a clinical decision-support system (CDSS) interposed at the time of electronic (e-) prescriptions for selected antibiotics. METHODS: This is a retrospective, observational intervention study, conducted within a large, statewide Veterans Affairs health system. Participants are outpatients with an initial visit for ARI. A CDSS was deployed upon e-prescription of selected antibiotics during the study period. From 01/2004 to 05/2006 (pre-withdrawal period), the CDSS targeted azithromycin and the fluoroquinolone gatifloxacin. From 05/2006 to 12/2011 (post-withdrawal period), the CDSS was retained for azithromycin but withdrawn for the fluoroquinolone. A manual record review was conducted to determine concordance of antibiotic prescription with ARI treatment guidelines. RESULTS: Of 1131 included ARI visits, 380 (33.6%) were guideline-concordant. For azithromycin, concordance did not change between the pre- and post-withdrawal periods, and adjusted odds of concordance was 8.8 for the full study period, compared to unrestricted antibiotics. For fluoroquinolones, guideline concordance decreased from 88.6% (39 of 44 visits) to 51.3% (59 of 115 visits), pre- vs. post-withdrawal periods (p < 0.005). The adjusted odds of concordance compared to “All Other Antibiotics” visits decreased from 24.4 (95% CI 9.0–66.3) pre-withdrawal to 5.5 (95% CI 3.5–8.8) post-withdrawal (p = .008). Concordance did not change between those same time periods for antibiotics that were never subjected to the intervention (“All Other Antibiotics”). CONCLUSIONS: A CDSS interposed at the time of e-prescription of selected antibiotics can shift their use toward ARI treatment guidelines, and this effect can be maintained over the long term as long as the CDSS remains in place. Removal of the CDSS after 3.5 years of implementation resulted in a rise in guideline-discordant antibiotic use. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12879-017-2602-7) contains supplementary material, which is available to authorized users. BioMed Central 2017-07-31 /pmc/articles/PMC5537944/ /pubmed/28760143 http://dx.doi.org/10.1186/s12879-017-2602-7 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Gifford, Jeneen
Vaeth, Elisabeth
Richards, Katherine
Siddiqui, Tariq
Gill, Christine
Wilson, Lucy
DeLisle, Sylvain
Decision support during electronic prescription to stem antibiotic overuse for acute respiratory infections: a long-term, quasi-experimental study
title Decision support during electronic prescription to stem antibiotic overuse for acute respiratory infections: a long-term, quasi-experimental study
title_full Decision support during electronic prescription to stem antibiotic overuse for acute respiratory infections: a long-term, quasi-experimental study
title_fullStr Decision support during electronic prescription to stem antibiotic overuse for acute respiratory infections: a long-term, quasi-experimental study
title_full_unstemmed Decision support during electronic prescription to stem antibiotic overuse for acute respiratory infections: a long-term, quasi-experimental study
title_short Decision support during electronic prescription to stem antibiotic overuse for acute respiratory infections: a long-term, quasi-experimental study
title_sort decision support during electronic prescription to stem antibiotic overuse for acute respiratory infections: a long-term, quasi-experimental study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537944/
https://www.ncbi.nlm.nih.gov/pubmed/28760143
http://dx.doi.org/10.1186/s12879-017-2602-7
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