Document Detail


A cluster randomized trial of decision support strategies for reducing antibiotic use in acute bronchitis.
MedLine Citation:
PMID:  23319069     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: National quality indicators show little change in the overuse of antibiotics for uncomplicated acute bronchitis. We compared the effect of 2 decision support strategies on antibiotic treatment of uncomplicated acute bronchitis.
METHODS: We conducted a 3-arm cluster randomized trial among 33 primary care practices belonging to an integrated health care system in central Pennsylvania. The printed decision support intervention sites (11 practices) received decision support for acute cough illness through a print-based strategy, the computer-assisted decision support intervention sites (11 practices) received decision support through an electronic medical record-based strategy, and the control sites (11 practices) served as a control arm. Both intervention sites also received clinician education and feedback on prescribing practices, as well as patient education brochures at check-in. Antibiotic prescription rates for uncomplicated acute bronchitis in the winter period (October 1, 2009, through March 31, 2010) following introduction of the intervention were compared with the previous 3 winter periods in an intent-to-treat analysis.
RESULTS: Compared with the baseline period, the percentage of adolescents and adults prescribed antibiotics during the intervention period decreased at the printed decision support intervention sites (from 80.0% to 68.3%) and at the computer-assisted decision support intervention sites (from 74.0% to 60.7%) but increased slightly at the control sites (from 72.5% to 74.3%). After controlling for patient and clinician characteristics, as well as clustering of observations by clinician and practice site, the differences for the intervention sites were statistically significant from the control sites (P = .003 for control sites vs printed decision support intervention sites and P = .01 for control sites vs computer-assisted decision support intervention sites) but not between themselves (P = .67 for printed decision support intervention sites vs computer-assisted decision support intervention sites). Changes in total visits, 30-day return visit rates, and proportion diagnosed as having uncomplicated acute bronchitis were similar among the study sites.
CONCLUSIONS: Implementation of a decision support strategy for acute bronchitis can help reduce the overuse of antibiotics in primary care settings. The effect of printed vs computer-assisted decision support strategies for providing decision support was equivalent.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00981994.
Authors:
Ralph Gonzales; Tammy Anderer; Charles E McCulloch; Judith H Maselli; Frederick J Bloom; Thomas R Graf; Melissa Stahl; Michelle Yefko; Julie Molecavage; Joshua P Metlay
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  JAMA internal medicine     Volume:  173     ISSN:  2168-6114     ISO Abbreviation:  JAMA Intern Med     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-26     Completed Date:  2013-04-16     Revised Date:  2013-08-28    
Medline Journal Info:
Nlm Unique ID:  101589534     Medline TA:  JAMA Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  267-73     Citation Subset:  AIM; IM    
Affiliation:
Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94118, USA. ralphg@medicine.ucsf.edu
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00981994
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MeSH Terms
Descriptor/Qualifier:
Acute Disease / therapy
Adolescent
Adult
Anti-Bacterial Agents / therapeutic use*
Bronchitis / drug therapy*
Cluster Analysis
Decision Support Techniques*
Drug Utilization / statistics & numerical data*,  trends
Female
Humans
Inappropriate Prescribing / prevention & control*
Male
Pennsylvania
Physician's Practice Patterns / standards*
Primary Health Care / methods
Grant Support
ID/Acronym/Agency:
K24 AI073957/AI/NIAID NIH HHS; R01CI000611/CI/NCPDCID CDC HHS
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents
Comments/Corrections
Comment In:
JAMA Intern Med. 2013 Feb 25;173(4):273-5   [PMID:  23318503 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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