A Cluster-Randomized Trial of Decision Support Strategies for Reducing Antibiotic Use for Acute Bronchitis
Published Date:Feb 25 2013
Source:JAMA Intern Med. 173(4):267-273.
Funding:K24 AI073957/AI/NIAID NIH HHS/United States
R01CI000611/CI/NCPDCID CDC HHS/United States
National quality indicators show little change in the overuse of antibiotics for uncomplicated acute bronchitis. We compared the impact of two decision support strategies on antibiotic treatment of uncomplicated acute bronchitis.
We conducted a three-arm, cluster-randomized trial among 33 primary care practices belonging to an integrated health care system in central Pennsylvania. The printed intervention arm (n=11 practices) received decision support for acute cough illness through a print-based strategy, the computerized intervention group (n=11) received decision support through an electronic medical record-based strategy, and third group of practices (n=11) served as the control arm. Both intervention groups also received provider education and feedback on prescribing practices, and patient education brochures at check-in. Antibiotic prescription rates for uncomplicated acute bronchitis in the winter period (October 2009 – March 2010) following introduction of the intervention were compared with the previous three winter periods in an intent-to-treat analysis.
Compared with the baseline period, the percentage of adolescents and adults prescribed antibiotics during the intervention period decreased at the printed (from 80.0% to 68.3%) and computerized intervention sites (from 74.0% to 60.7%), but increased slightly at the control sites (from 72.5% to 74.3%). After controlling for patient and provider characteristics, and clustering of observations by provider and practice site, the differences for the intervention groups were statistically significant from control (control vs. printed P=0.003; control vs. computerized P=0.014) but no among themselves (printed vs. computerized P=0.67). Changes in total visits, proportion diagnosed as uncomplicated acute bronchitis and thirty-day return visit rates were similar between study groups.
Implementation of a decision support strategy for acute bronchitis can help reduce overuse of antibiotics in primary care settings. The impact of printed and computerized strategies for providing decision support was equivalent. The study was registered with Clinical Trials.Gov prior to enrolling patients (NCT00981994).
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