title: Use of a personal digital assistant for managing antibiotic prescribing for outpatient respiratory tract infections in rural communities.
abstract: OBJECTIVE
  To assess the acceptability and usage of a standalone personal digital assistant (PDA)-based clinical decision-support system (CDSS) for the diagnosis and management of acute respiratory tract infections (RTIs) in the outpatient setting.
  
  
  METHODS
  Observational study performed as part of a larger randomized trial in six rural communities in Utah and Idaho from January 2002 to March 2004. Ninety-nine primary care providers received a PDA-based CDSS for use at the point-of-care, and were asked to use the tool with at least 200 patients with suspected RTIs.
  
  
  METHODS
  Clinical data were collected electronically from the devices at periodic intervals. Providers also completed an exit questionnaire at the end of the study period.
  
  
  RESULTS
  Providers logged 14,393 cases using the CDSS, the majority of which (n=7624; 53%) were from family practitioners. Overall adherence with CDSS recommendations for the five most common diagnoses (pharyngitis, otitis media, sinusitis, bronchitis, and upper respiratory tract infection) was 82%. When antibiotics were prescribed (53% of cases), adherence with the CDSS-recommended antibiotic was high (76%). By logistic regression analysis, the odds of adherence with CDSS recommendations increased significantly with each ten cases completed (P=0.001). Questionnaire respondents believed the CDSS was easy to use, and most (44/65; 68%) did not believe it increased their encounter time with patients, regardless of prior experience with PDAs.
  
  
  CONCLUSIONS
  A standalone PDA-based CDSS for acute RTIs used at the point-of-care can encourage better outpatient antimicrobial prescribing practices and easily gather a rich set of clinical data.
authors.affiliation: Department of Internal Medicine, University of Utah School of Medicine, 300 North 1900 East, Room AC-230A, Salt Lake City, UT 84132, USA. Michael.Rubin@hsc.utah.edu
authors.forename: Michael A
authors.initials: MA
authors.lastname: Rubin
authors.forename: Kim
authors.initials: K
authors.lastname: Bateman
authors.forename: Sharon
authors.initials: S
authors.lastname: Donnelly
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Stoddard
authors.forename: Kurt
authors.initials: K
authors.lastname: Stevenson
authors.forename: Reed M
authors.initials: RM
authors.lastname: Gardner
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Samore
mesh_terms: D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001292:Attitude to Computers; D034201:Computers, Handheld / Q000706:statistics & numerical data*; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D019370:Observation; D019095:Point-of-Care Systems; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy*; D019035:Rural Health Services; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents