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Antibiotic prescriptions for acute bronchitis decreased with decision support strategies
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Using decision support strategies reduced the number of antibiotic prescriptions for acute bronchitis, according to recent data.
“The overuse of antibiotics for acute respiratory tract infections is an important contributor to worsening trends in antibiotic-resistance patterns among community-acquired pathogens,” researchers wrote in JAMA Internal Medicine. “Although national and local efforts seem to have helped reduce antibiotic use for some acute respiratory infections, reducing antibiotic treatment of acute bronchitis remains a challenge.”
Researchers from the division of internal medicine at University of California, San Francisco, and the Geisinger Health System in Danville, Pa., conducted a three-arm cluster randomized trial that included 33 primary care practices in central Pennsylvania. Eleven sites used printed decision support, giving patients with cough an educational brochure. Eleven practices used a computer-based strategy: When triage nurses entered cough in the electronic medical record, an alert would appear prompting the nurse to provide a brochure to the patient. The remaining 11 sites had no intervention.
The number of antibiotic prescriptions for acute bronchitis after the intervention was compared with the number of prescriptions during a baseline period. The analysis was restricted to Oct. 1 to March 31 of each time period. During the baseline period, there were 9,808 incidents of uncomplicated acute bronchitis, and during the intervention period, there were 6,242 incidents.
At sites using printed decision support, the number of adolescents and adults prescribed antibiotics reduced from 80% in the baseline period to 68.3% during the intervention period. For the computer-based strategy, the antibiotic prescription rate decreased from 74% in the baseline period to 60.7% in the intervention period. The rate increased at the control sites, from 72.5% to 74.3%. After controlling for patient temperature, respiratory rate, smoking, clinician specialty and clinician observations, the difference was statistically significant.
“An evidence-based algorithm to guide management of acute bronchitis can reduce the overuse of antibiotics in primary care settings, but the mode of implementation does not seem to influence the magnitude of effect,” the researchers wrote. “Studies of computer-assisted decision support tools that do not include a comparison with more traditional implementation strategies may significantly overestimate the value of this type of decision support.”
Disclosure: Two researchers report financial relationships with Phreesia Inc. and Merck.
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