title: Improving diagnostic testing and reducing overuse of antibiotics for children with pharyngitis: a useful role for the electronic medical record.
abstract: BACKGROUND
  Because of rising resistance to antibiotics, appropriate use of antibiotics is an important measure of quality of care. The purpose of this study was to use an electronic medical record (EMR) to assess use of diagnostic testing and of antibiotics for pharyngitis in a pediatric outpatient setting and to target areas for improvement.
  
  
  METHODS
  Using data retrieved from the EMR, we analyzed visits from March 1, 2001 to February 28, 2002 for children 3 to 18 years old diagnosed with pharyngitis. We determined the proportion of episodes with a diagnostic test for group A streptococci, the proportion for which a prescription for an antibiotic was dispensed and factors that predicted prescribing and testing.
  
  
  RESULTS
  Of 391 episodes of pharyngitis, a test was ordered for 303 (78%). Antibiotics were prescribed for 90 (23%); for 76 of 90 (84%) a test was ordered. Clinicians were less likely to order tests late in the week [relative risk (RR), 0.76; 95% confidence interval (CI), 0.66, 0.87)], more likely to order tests for patients with an exudate (RR 1.2; 95% CI 1.1, 1.3) and more likely to prescribe an antibiotic for patients with an exudate (RR 1.5; 95% CI 1.1, 2.1). When prescribing an antibiotic clinicians were less likely to order tests late in the week (RR 0.1; 95% CI 0.02, 0.5) and for patients diagnosed with scarlet fever (RR 0.07; 95% CI 0.01, 0.4).
  
  
  CONCLUSIONS
  Using data from the EMR, we could assess adherence to the guidelines for antibiotic use and identify areas to target for improving diagnostic testing and reducing overuse of antibiotics in our clinic.
authors.affiliation: Yale School of Medicine, Robert Wood Johnson Clinical Scholars Program, New Haven, CT, USA.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Benin
authors.forename: Grace
authors.initials: G
authors.lastname: Vitkauskas
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Thornquist
authors.forename: Richard N
authors.initials: RN
authors.lastname: Shiffman
authors.forename: John
authors.initials: J
authors.lastname: Concato
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.forename: Eugene D
authors.initials: ED
authors.lastname: Shapiro
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003955:Diagnostic Tests, Routine; D018432:Drug Resistance, Multiple; D004363:Drug Utilization / Q000592:standards / Q000639:trends; D001330:Electronic Data Processing; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D010612:Pharyngitis / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D011336:Probability; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
chemical_list: D000900:Anti-Bacterial Agents