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Clinical decision system helps reduce inappropriate antimicrobial prescribing

al included 407,460 inhabitants and 334 primary care clinicians in 12 rural communities in Utah and Idaho and a third group of 6 communities that served as nonstudy controls. The pre-intervention period was January to December 2001 and the postintervention period was January 2002 to September 2003. Six communities received a community intervention alone and 6 communities received community intervention plus CDSS that were targeted toward primary care clinicians. Community-wide antimicrobial usage was assessed using retail pharmacy data. Diagnosis-specific antimicrobial use was compared by chart review.

Within CDSS communities, 71 percent of primary care clinicians participated in the use of CDSS. The researchers found that during the second-intervention year, prescribing rates in CDSS communities decreased 10 percent from baseline, whereas in the community intervention?alone communities and nonstudy communities, prescribing rates in 2003 increased by 1 percent and 6 percent, respectively. The prescribing rate decreased from 84.1 to 75.3 per 100 person-years in the CDSS group vs. 84.3 to 85.2 in community intervention alone, and remained stable in the other communities. A total of 13,081 acute respiratory infection visits were documented for this study. The relative decrease in antimicrobial prescribing for visits in the antibiotics "never-indicated" category during the post-intervention period was 32 percent in CDSS communities and 5 percent in community intervention-alone communities. Use of macrolides decreased significantly in CDSS communities but not in community intervention-alone communities.

"This trial demonstrated the feasibility, uptake, and benefit of stand-alone, portable CDSS tools for acute respiratory infections in rural primary care settings. The CDSS decreased unnecessary use of antimicrobial agents for viral respiratory tract infections and improved antimicrobial agent selection," the authors write.

"An unresolved question
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Contact: Chantelle Turner
801-581-5717
JAMA and Archives Journals
8-Nov-2005


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