title: An electronic chart prompt to decrease proprietary antibiotic prescription to self-pay patients.
abstract: OBJECTIVE
  Emergency physicians unaware of patients' insurance status may prescribe expensive proprietary antibiotics for patients who cannot afford them. The objective of this study was to develop a clinical decision support system to display patient insurance status before prescription writing for outpatient conditions.
  
  
  METHODS
  This was a 26-week "before-and-after" trial at an urban emergency department (ED) with 78,000 visits/year treating a medically underserved population. Sixty-one prescribers, including attending physicians, residents, and physician assistants, participated. All patients older than 18 years of age discharged from the ED receiving antibiotic prescriptions were eligible. The electronic ED chart is linked to prescription-writing software, which includes a menu of 74 antibiotics. The system was programmed so that when an emergency physician accessed the prescription menu, a prompt appeared displaying insurance status. Prescribers also received educational interventions. The main outcome measure was the percentage of prescribers who reduced their prescription writing of proprietary antibiotics to self-pay patients. Data were analyzed with cluster techniques using SPSS 10.0 (SPSS Inc., Chicago, IL).
  
  
  RESULTS
  Of 594 prescriptions written for self-pay patients before prompt insertion, 158 (26.6%) were for proprietary antibiotics. After the intervention, self-pay patients received 564 antibiotic prescriptions, of which 117 (20.7%) were for proprietary drugs. Analyzed by prescriber, the reduction in the prescription rate for proprietary antibiotics was statistically significant (p = 0.03, chi(2) test). Patients with respiratory or urinary infections also had a statistically significant reduction in proprietary antibiotic prescription (p = 0.03).
  
  
  CONCLUSIONS
  A clinical decision support system, integrated into a prescription-writing program, can decrease the prescription of proprietary antibiotics for self-pay patients in the ED.
authors.affiliation: Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA. sbernste@montefiore.org
authors.forename: Steven L
authors.initials: SL
authors.lastname: Bernstein
authors.forename: David
authors.initials: D
authors.lastname: Whitaker
authors.forename: Jonathan
authors.initials: J
authors.lastname: Winograd
authors.forename: John A
authors.initials: JA
authors.lastname: Brennan
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D020000:Decision Support Systems, Clinical / Q000295:instrumentation*; D011307:Drug Prescriptions / Q000191:economics*; D004635:Emergency Medicine / Q000295:instrumentation*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized / Q000295:instrumentation*; D017057:Medically Uninsured; D009515:New Jersey; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians'; D017010:Reminder Systems / Q000295:instrumentation
chemical_list: D000900:Anti-Bacterial Agents