TY - JOUR
T1 - Decision support during electronic prescription to stem antibiotic overuse for acute respiratory infections
T2 - A long-term, quasi-experimental study
AU - Gifford, Jeneen
AU - Vaeth, Elisabeth
AU - Richards, Katherine
AU - Siddiqui, Tariq
AU - Gill, Christine
AU - Wilson, Lucy
AU - DeLisle, Sylvain
N1 - Funding Information:
The authors declare financial support from the Department of Veterans Affairs (TQ,CF, and SD) and the Centers for Disease Control and Prevention (EV,KR,LW, and SD). The funding bodies had no role in the collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.
Funding Information:
This material is the result of work supported with resources and the use of facilities at the VA Maryland Health Care System. This work was also supported in part by grants SHP-08-162 and IIR 06–119-1 from the Office of Research and Development, Health Services Research and Development Service, Department of Veterans Affairs. Components of the study involving evaluation of the effects of the CDSS and its removal were also supported by funding through the Maryland Department of Health and Mental Hygiene’s work with the Get Smart: Know When Antibiotics Work program, part of the Centers for Disease Control and Prevention’s Epidemiology and Laboratory Capacity for Infectious Diseases Cooperative Agreement.
Publisher Copyright:
© 2017 The Author(s).
PY - 2017/7/31
Y1 - 2017/7/31
N2 - 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 From 05/2006 to 12/2011 (post-withdrawal period), the CDSS was retained for azithromycin but withdrawn for the fluoroquinolone.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 3.5years of implementation resulted in a rise in guideline-discordant antibiotic use.
AB - 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 3.5years of implementation resulted in a rise in guideline-discordant antibiotic use.
UR - http://www.scopus.com/inward/record.url?scp=85026541561&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85026541561&partnerID=8YFLogxK
U2 - 10.1186/s12879-017-2602-7
DO - 10.1186/s12879-017-2602-7
M3 - Article
C2 - 28760143
AN - SCOPUS:85026541561
SN - 1471-2334
VL - 17
JO - BMC Infectious Diseases
JF - BMC Infectious Diseases
IS - 1
M1 - 528
ER -