title: Experience with a clinical decision support system in community pharmacies to recommend narrow-spectrum antimicrobials, nonantimicrobial prescriptions, and OTC products to decrease broad-spectrum antimicrobial use.
abstract: BACKGROUND
  Overuse of antibiotics increases the incidence of bacterial resistance and contributes avoidable costs to the health care system.
  
  
  OBJECTIVE
  To determine the feasibility of a protocol-driven community pharmacy intervention that was designed to decrease broad-spectrum antimicrobial (BSA) use in patients with upper respiratory tract infections.
  
  
  METHODS
  The intervention involved pharmacists who conducted guided interviews regarding patient symptoms in a cohort of patients with BSA prescription visiting 2 rural community pharmacies during peak respiratory illness season. A clinical decision support system was provided to aid in pharmacist diagnosis and assist in determining if the BSA therapy was appropriate. Upon patient consent, pharmacists attempted to contact primary care providers (PCPs) to confirm the diagnosis and recommend appropriate alternative therapy.
  
  
  RESULTS
  There were 192 subjects with prescriptions for BSAs and symptoms of respiratory tract infection. Only 3% of the patients who were approached declined to discuss their symptoms and treatment with the pharmacist. A mean of 3 minutes was required to collect symptom and treatment information from the patients. However, when patients were asked if the pharmacist could contact their PCP to recommend alternative therapy, only 7% (n=4) of patients agreed to the intervention. The PCPs who were contacted by pharmacists were receptive to altering the BSA to first-line antimicrobial therapy such as amoxicillin or doxycycline.
  
  
  CONCLUSIONS
  Despite a description of the importance of the intervention, more than 90% of patients prescribed a BSA declined to permit the community pharmacist to contact the prescriber to discuss first-line therapeutic alternatives. This experience in a pilot study to explore the feasibility of pharmacist intervention at the point of dispensing of a BSA made clear that a successful community pharmacy intervention to reduce BSA use would require an alternative method, perhaps via a collaborative practice protocol that does not require patient consent to make the drug substitution to first-line antibiotic therapy.
authors.affiliation: ISU College of Pharmacy, c/o Boise VA Medical Center, 500 W Fort St. (119A), Boise, ID 83702, USA. KMK@otc.isu.edu
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Madaras-Kelly
authors.forename: Elizabeth Lyon
authors.initials: EL
authors.lastname: Hannah
authors.forename: Kim
authors.initials: K
authors.lastname: Bateman
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Samore
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003157:Community Pharmacy Services; D034201:Computers, Handheld; D020000:Decision Support Systems, Clinical; D024881:Drug Resistance, Bacterial; D006801:Humans; D007061:Idaho; D004366:Nonprescription Drugs / Q000627:therapeutic use; D010353:Patient Education as Topic; D010594:Pharmacies; D010595:Pharmacists; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D012651:Self Medication
chemical_list: D000900:Anti-Bacterial Agents; D004366:Nonprescription Drugs