title: Impact of a clinical decision support system on antibiotic prescribing for acute respiratory infections in primary care: quasi-experimental trial.
abstract: OBJECTIVE
  To assess the effect of a clinical decision support system (CDSS) integrated into an electronic health record (EHR) on antibiotic prescribing for acute respiratory infections (ARIs) in primary care.
  
  
  METHODS
  Quasi-experimental design with nine intervention practices and 61 control practices in the Practice Partner Research Network, a network of practices which all use the same EHR (Practice Partner). The nine intervention practices were located in nine US states. The design included a 3-month baseline data collection period (October through December 2009) before the introduction of the intervention and 15 months of follow-up (January 2010 through March 2011). The main outcome measures were the prescribing of antibiotics in ARI episodes for which antibiotics are inappropriate and prescribing of broad-spectrum antibiotics in all ARI episodes.
  
  
  RESULTS
  In adult patients, prescribing of antibiotics in ARI episodes where antibiotics are inappropriate declined more (-0.6%) among intervention practices than in control practices (+4.2%) (p=0.03). However, among adults, the CDSS intervention improved prescribing of broad-spectrum antibiotics, with a decline of 16.6% among intervention practices versus an increase of 1.1% in control practices (p<0.0001). A similar effect on broad-spectrum antibiotic prescribing was found in pediatric patients with a decline of 19.7% among intervention practices versus an increase of 0.9% in control practices (p<0.0001).
  
  
  CONCLUSIONS
  A CDSS embedded in an EHR had a modest effect in changing prescribing for adults where antibiotics were inappropriate but had a substantial impact on changing the overall prescribing of broad-spectrum antibiotics among pediatric and adult patients.
authors: Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29425, USA. mainouag@musc.edu
authors: Arch G
authors: AG
authors: Mainous
authors: Carol A
authors: CA
authors: Lambourne
authors: Paul J
authors: PJ
authors: Nietert
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D020000:Decision Support Systems, Clinical; D057286:Electronic Health Records; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D057970:Inappropriate Prescribing; D016014:Linear Models; D008297:Male; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D018511:Systems Integration; D014481:United States; D014584:User-Computer Interface
chemical_list: D000900:Anti-Bacterial Agents