CDS could promote more judicious antibiotic use

Clinical decision support (CDS) could help reduce the inappropriate use of antibiotics to treat acute respiratory infections, according to research published online Nov. 2 by the Journal of General Internal Medicine.

A CDS tool designed as an EHR progress note was implemented in nine primary care practices using a common EHR associated with the Practice Partner Research Network, a research collaborative affiliated with the Medical University of South Carolina (MUSC) in Charleston. MUSC researchers then examined the effects in two phases over the course of 27 months.

The CDS tool, relying on diagnosis and treatment guidelines established by the Centers for Disease Control and Prevention, facilitated proper diagnosis of acute respiratory infections by making recommendations for testing based on patient history and embedded treatment prompts made suggestions regarding the appropriate use of narrow spectrum antibiotics to treat acute respiratory infections.

Researchers determined that the CDS tool was used during 38,492 encounters during the 27-month intervention period and that at least one acute respiratory infection diagnosis was made during 93 percent of those encounters. While the CDS was widely used across all nine practices, researchers did not conclude that the intervention significantly impacted the the overall use of antibiotics for acute respiratory infections. However, use of broad spectrum antibiotics for children and adults decline an estimated 16 percent, a relative reduction of about 30 percent for adults and 45 percent for children.

“Because the use of broad spectrum antibiotic use has been associated with increasing antibiotic resistance, this substantial reduction of broad spectrum antibiotic use has promising public health implications,” wrote lead author Cara B. Litvin, MD, assistant professor in the division of general internal medicine and geriatrics at MUSC.

Despite the promising implications, the study also sheds light on the challenges associated with developing more standardized practices for prescribing antibiotics to treat acute respiratory infections, according to Litvin. Some providers reported patient expectations of antibiotics, some reported concern that they may have missed a more serious diagnosis and some reported disagreement with the guidelines.