Impact of clinical decision support on receipt of antibiotic prescriptions for acute bronchitis and upper respiratory tract infection

Jeffrey McCullough, Frederick J. Zimmerman, Hector P. Rodriguez

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

OBJECTIVE: Antibiotics are commonly recognized as non-indicated for acute bronchitis and upper respiratory tract infection (URI), yet their widespread use persists. Clinical decision support in the form of electronic warnings is hypothesized to prevent non-indicated prescriptions. The purpose of this study was to identify the effect of clinical decision support on a common type of non-indicated prescription.

MATERIALS AND METHODS: Using National Ambulatory Medical Care Survey data from 2006 to 2010, ambulatory visits with a primary diagnosis of acute bronchitis or URI and orders for antibiotic prescriptions were identified. Visits were classified on the basis of clinician report of decision-support use. Generalized estimating equations were used to assess the effect of decision support on likelihood of antibiotic prescription receipt, controlling for patient, provider, and practice characteristics.

RESULTS: Clinician use of decision support increased sharply between 2006 (16% of visits) and 2010 (55%). Antibiotic prescribing for acute bronchitis and URI increased from ∼35% of visits in 2006 to ∼45% by 2010. Use of decision support was associated with a 19% lower likelihood of receiving an antibiotic prescription, controlling for patient, provider, and practice characteristics.

DISCUSSION: In spite of the increased use of decision-support systems and the relatively fewer non-indicated antibiotic prescriptions resulting from the use of decision support, a secular upward trend in non-indicated antibiotic prescribing offset these improvements.

CONCLUSIONS: The overall effect of decision support suggests an important role for technology in reducing non-indicated prescriptions. Decision support alone may not be sufficient to eliminate non-indicated prescriptions given secular trends.

Original languageEnglish (US)
Pages (from-to)1091-1097
Number of pages7
JournalJournal of the American Medical Informatics Association : JAMIA
Volume21
Issue number6
DOIs
StatePublished - Nov 1 2014

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Clinical Decision Support Systems
Bronchitis
Respiratory Tract Infections
Prescriptions
Anti-Bacterial Agents
Health Care Surveys
Technology

Keywords

  • Acute bronchitis
  • Antibiotics
  • Health information technology

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Impact of clinical decision support on receipt of antibiotic prescriptions for acute bronchitis and upper respiratory tract infection. / McCullough, Jeffrey; Zimmerman, Frederick J.; Rodriguez, Hector P.

In: Journal of the American Medical Informatics Association : JAMIA, Vol. 21, No. 6, 01.11.2014, p. 1091-1097.

Research output: Contribution to journalArticle

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