Decision support during electronic prescription to stem antibiotic overuse for acute respiratory infections: A long-term, quasi-experimental study

Jeneen Gifford, Elisabeth Vaeth, Katherine Richards, Tariq Siddiqui, Christine Gill, Lucy Wilson, Sylvain DeLisle

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Interventions to support decision-making can reduce inappropriate antibiotic use for acute respiratory infections (ARI), but they may not be sustainable. The objective of the study is to evaluate the long-term effectiveness of a clinical decision-support system (CDSS) interposed at the time of electronic (e-) prescriptions for selected antibiotics. Methods: This is a retrospective, observational intervention study, conducted within a large, statewide Veterans Affairs health system. Participants are outpatients with an initial visit for ARI. A CDSS was deployed upon e-prescription of selected antibiotics during the study period. From 01/2004 to 05/2006 (pre-withdrawal period), the CDSS targeted azithromycin and the fluoroquinolone gatifloxacin. From 05/2006 to 12/2011 (post-withdrawal period), the CDSS was retained for azithromycin but withdrawn for the fluoroquinolone. A manual record review was conducted to determine concordance of antibiotic prescription with ARI treatment guidelines. Results: Of 1131 included ARI visits, 380 (33.6%) were guideline-concordant. For azithromycin, concordance did not change between the pre- and post-withdrawal periods, and adjusted odds of concordance was 8.8 for the full study period, compared to unrestricted antibiotics. For fluoroquinolones, guideline concordance decreased from 88.6% (39 of 44 visits) to 51.3% (59 of 115 visits), pre- vs. post-withdrawal periods (p<0.005). The adjusted odds of concordance compared to "All Other Antibiotics" visits decreased from 24.4 (95% CI 9.0-66.3) pre-withdrawal to 5.5 (95% CI 3.5-8.8) post-withdrawal (p=.008). Concordance did not change between those same time periods for antibiotics that were never subjected to the intervention ("All Other Antibiotics"). Conclusions: A CDSS interposed at the time of e-prescription of selected antibiotics can shift their use toward ARI treatment guidelines, and this effect can be maintained over the long term as long as the CDSS remains in place. Removal of the CDSS after 3.5years of implementation resulted in a rise in guideline-discordant antibiotic use.

Original languageEnglish (US)
Article number528
JournalBMC Infectious Diseases
Volume17
Issue number1
DOIs
StatePublished - Jul 31 2017

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Electronic Prescribing
Clinical Decision Support Systems
Respiratory Tract Infections
Anti-Bacterial Agents
Azithromycin
Guidelines
Fluoroquinolones
Prescriptions
Non-Randomized Controlled Trials
Veterans Health
Observational Studies
Decision Making
Outpatients

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Decision support during electronic prescription to stem antibiotic overuse for acute respiratory infections : A long-term, quasi-experimental study. / Gifford, Jeneen; Vaeth, Elisabeth; Richards, Katherine; Siddiqui, Tariq; Gill, Christine; Wilson, Lucy; DeLisle, Sylvain.

In: BMC Infectious Diseases, Vol. 17, No. 1, 528, 31.07.2017.

Research output: Contribution to journalArticle

Gifford, Jeneen ; Vaeth, Elisabeth ; Richards, Katherine ; Siddiqui, Tariq ; Gill, Christine ; Wilson, Lucy ; DeLisle, Sylvain. / Decision support during electronic prescription to stem antibiotic overuse for acute respiratory infections : A long-term, quasi-experimental study. In: BMC Infectious Diseases. 2017 ; Vol. 17, No. 1.
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abstract = "Background: Interventions to support decision-making can reduce inappropriate antibiotic use for acute respiratory infections (ARI), but they may not be sustainable. The objective of the study is to evaluate the long-term effectiveness of a clinical decision-support system (CDSS) interposed at the time of electronic (e-) prescriptions for selected antibiotics. Methods: This is a retrospective, observational intervention study, conducted within a large, statewide Veterans Affairs health system. Participants are outpatients with an initial visit for ARI. A CDSS was deployed upon e-prescription of selected antibiotics during the study period. From 01/2004 to 05/2006 (pre-withdrawal period), the CDSS targeted azithromycin and the fluoroquinolone gatifloxacin. From 05/2006 to 12/2011 (post-withdrawal period), the CDSS was retained for azithromycin but withdrawn for the fluoroquinolone. A manual record review was conducted to determine concordance of antibiotic prescription with ARI treatment guidelines. Results: Of 1131 included ARI visits, 380 (33.6{\%}) were guideline-concordant. For azithromycin, concordance did not change between the pre- and post-withdrawal periods, and adjusted odds of concordance was 8.8 for the full study period, compared to unrestricted antibiotics. For fluoroquinolones, guideline concordance decreased from 88.6{\%} (39 of 44 visits) to 51.3{\%} (59 of 115 visits), pre- vs. post-withdrawal periods (p<0.005). The adjusted odds of concordance compared to {"}All Other Antibiotics{"} visits decreased from 24.4 (95{\%} CI 9.0-66.3) pre-withdrawal to 5.5 (95{\%} CI 3.5-8.8) post-withdrawal (p=.008). Concordance did not change between those same time periods for antibiotics that were never subjected to the intervention ({"}All Other Antibiotics{"}). Conclusions: A CDSS interposed at the time of e-prescription of selected antibiotics can shift their use toward ARI treatment guidelines, and this effect can be maintained over the long term as long as the CDSS remains in place. Removal of the CDSS after 3.5years of implementation resulted in a rise in guideline-discordant antibiotic use.",
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T2 - A long-term, quasi-experimental study

AU - Gifford, Jeneen

AU - Vaeth, Elisabeth

AU - Richards, Katherine

AU - Siddiqui, Tariq

AU - Gill, Christine

AU - Wilson, Lucy

AU - DeLisle, Sylvain

PY - 2017/7/31

Y1 - 2017/7/31

N2 - Background: Interventions to support decision-making can reduce inappropriate antibiotic use for acute respiratory infections (ARI), but they may not be sustainable. The objective of the study is to evaluate the long-term effectiveness of a clinical decision-support system (CDSS) interposed at the time of electronic (e-) prescriptions for selected antibiotics. Methods: This is a retrospective, observational intervention study, conducted within a large, statewide Veterans Affairs health system. Participants are outpatients with an initial visit for ARI. A CDSS was deployed upon e-prescription of selected antibiotics during the study period. From 01/2004 to 05/2006 (pre-withdrawal period), the CDSS targeted azithromycin and the fluoroquinolone gatifloxacin. From 05/2006 to 12/2011 (post-withdrawal period), the CDSS was retained for azithromycin but withdrawn for the fluoroquinolone. A manual record review was conducted to determine concordance of antibiotic prescription with ARI treatment guidelines. Results: Of 1131 included ARI visits, 380 (33.6%) were guideline-concordant. For azithromycin, concordance did not change between the pre- and post-withdrawal periods, and adjusted odds of concordance was 8.8 for the full study period, compared to unrestricted antibiotics. For fluoroquinolones, guideline concordance decreased from 88.6% (39 of 44 visits) to 51.3% (59 of 115 visits), pre- vs. post-withdrawal periods (p<0.005). The adjusted odds of concordance compared to "All Other Antibiotics" visits decreased from 24.4 (95% CI 9.0-66.3) pre-withdrawal to 5.5 (95% CI 3.5-8.8) post-withdrawal (p=.008). Concordance did not change between those same time periods for antibiotics that were never subjected to the intervention ("All Other Antibiotics"). Conclusions: A CDSS interposed at the time of e-prescription of selected antibiotics can shift their use toward ARI treatment guidelines, and this effect can be maintained over the long term as long as the CDSS remains in place. Removal of the CDSS after 3.5years of implementation resulted in a rise in guideline-discordant antibiotic use.

AB - Background: Interventions to support decision-making can reduce inappropriate antibiotic use for acute respiratory infections (ARI), but they may not be sustainable. The objective of the study is to evaluate the long-term effectiveness of a clinical decision-support system (CDSS) interposed at the time of electronic (e-) prescriptions for selected antibiotics. Methods: This is a retrospective, observational intervention study, conducted within a large, statewide Veterans Affairs health system. Participants are outpatients with an initial visit for ARI. A CDSS was deployed upon e-prescription of selected antibiotics during the study period. From 01/2004 to 05/2006 (pre-withdrawal period), the CDSS targeted azithromycin and the fluoroquinolone gatifloxacin. From 05/2006 to 12/2011 (post-withdrawal period), the CDSS was retained for azithromycin but withdrawn for the fluoroquinolone. A manual record review was conducted to determine concordance of antibiotic prescription with ARI treatment guidelines. Results: Of 1131 included ARI visits, 380 (33.6%) were guideline-concordant. For azithromycin, concordance did not change between the pre- and post-withdrawal periods, and adjusted odds of concordance was 8.8 for the full study period, compared to unrestricted antibiotics. For fluoroquinolones, guideline concordance decreased from 88.6% (39 of 44 visits) to 51.3% (59 of 115 visits), pre- vs. post-withdrawal periods (p<0.005). The adjusted odds of concordance compared to "All Other Antibiotics" visits decreased from 24.4 (95% CI 9.0-66.3) pre-withdrawal to 5.5 (95% CI 3.5-8.8) post-withdrawal (p=.008). Concordance did not change between those same time periods for antibiotics that were never subjected to the intervention ("All Other Antibiotics"). Conclusions: A CDSS interposed at the time of e-prescription of selected antibiotics can shift their use toward ARI treatment guidelines, and this effect can be maintained over the long term as long as the CDSS remains in place. Removal of the CDSS after 3.5years of implementation resulted in a rise in guideline-discordant antibiotic use.

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