Impact of a computerized template on antibiotic prescribing for acute respiratory infections in children and adolescents.
BACKGROUND
Computerized decision support (CDS) can potentially improve patient safety and guideline adherence. The authors developed an acute respiratory illness interactive template (ARI-IT) within an electronic health record (EHR) to manage pediatric ARIs and assessed the impact on antibiotic prescribing.


METHODS
They randomized 12 practices either to receive the ARI-IT or to the control group. Antibiotic rates among all eligible ARI diagnoses were compared among control and intervention ARI visits, controlling for clustering by clinician.


RESULTS
There was no difference in total antibiotic prescriptions between control and intervention clinics. Use of the ARI-IT significantly reduced antibiotic prescriptions (31.7% vs 39.9%; P = .02) and use of macrolides (6.2% vs 9.5%; P = .02) among visits compared with those eligible visits where it was not used.


CONCLUSIONS
Use of the CDS reduced antibiotic prescribing and macrolide prescriptions among children with an ARI. Nonetheless, the low overall use resulted in an ineffective intervention.
Bourgeois
Fabienne C
FC
Children's Hospital Boston, Boston, MA 02115, USA. fabienne.bourgeois@childrens.harvard.edu
Linder
Jeffrey
J
Johnson
Sarah A
SA
Co
John Patrick T
JP
Fiskio
Julie
J
Ferris
Timothy G
TG
D000208:Acute Disease; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D011307:Drug Prescriptions / Q000592:standards*; D005260:Female; D006801:Humans; D018942:Macrolides / Q000008:administration & dosage*; D008297:Male; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data; D012141:Respiratory Tract Infections / Q000188:drug therapy*
D000900:Anti-Bacterial Agents; D018942:Macrolides