Abstract
BackgroundDue to increasing bacterial resistance rates choosing a correct empiric antibiotic therapy is getting more and more complex. Often medical doctors use information tools to make the right treatment choice.MethodsOne hundred sixty six participants (77 medical doctors and 89 medical students) were asked to provide a diagnosis and antibiotic therapy in a simple fictive paper case of upper urinary tract infection (UTI) in a randomized single-blinded study. Participants were randomized to one of four information tools they were allowed to use in the study or control: 1. free internet access, 2. pharmaceutical pocket guide, 3. pocket guide antibiotic therapy, 4. clinical decision support system (CDSS), and control (no information tool). The CDSS was designed for the study. The adherence to the national German UTI guideline was evaluated.ResultsOnly 27.1% (n = 45/166) provided a correct diagnosis of upper UTI and 19.4% (n = 32/166) an antibiotic treatment recommended by national German treatment guidelines indicating their need for information tools. This result was not significantly different between medical doctors and medical students, residents and medical specialists or level of working experience. Using CDSS improved results significantly compared to conventional tools (diagnosis 57.1%; treatment recommendation 40.5%; p < 0,01). Processing time was not different between the use of CDSS and conventional information tools. CDSS users based their decision making on their assigned information tool more than users of conventional tools (73.8% vs. 48.0%; p < 0.01). Using CDSS improved the confidence of participants in their recommendation significantly compared to conventional tools (p < 0.01).ConclusionsOur study suggests that medical professionals require information tools in diagnosing and treating a simple case of upper UTI correctly. CDSS appears to be superior to conventional tools as an information source.
Highlights
Due to increasing bacterial resistance rates choosing a correct empiric antibiotic therapy is getting more and more complex
166 participants were included in the analysis, 46.4% (n = 77/166) medical doctors and 53.6% (n = 89/166) medical students (Table 1)
clinical decision support system (CDSS) users based their decision making on their assigned information tool more than users of conventional tools (73.8% vs. 48.0%; p < 0.01; Table 5)
Summary
Due to increasing bacterial resistance rates choosing a correct empiric antibiotic therapy is getting more and more complex. Due to irrational prescribing practices, the rate of multiresistant bacteria has dramatically increased over the last years, and it is more and more challenging to recommend effective empiric antibiotic therapy [3, 4] Despite these circumstances, medical doctors often continue to prescribe antibiotics unreasonably in their daily routine [5, 6]. Clinical decision support system Antibiotic Stewardship (ABS) Programs are implemented to ensure the rational use of antibiotics [7] These programs aim to optimize antibiotic prescriptions to increase guideline adherence, often leading to a reduction in overall antibiotic use [7]. ABS programs have become an integral part of medicine in the last years [8, 9]
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