Abstract
Objectives:Having shown previously that an electronic prescription writer and decision support system improved pediatric prescribing behavior for otitis media in an academic clinic setting, we assessed whether point-of-care delivery of evidence could demonstrate similar effects for a wide range of other common pediatric conditions.Design:Cluster randomized controlled trial.Setting:A teaching clinic/clinical practice site and a primary care pediatric clinic serving a rural and semi-urban patient mix.Participants:A total of 36 providers at the teaching clinic/practice site and eight providers at the private primary pediatric clinic.Intervention:An evidence-based message system that presented real-time evidence to providers based on prescribing practices for acute otitis media, allergic rhinitis, sinusitis, constipation, pharyngitis, croup, urticaria, and bronchiolitis.Outcome measures:The proportion of prescriptions dispensed in accordance with evidence.Results:The proportion of prescriptions dispensed in accordance with evidence improved four percentage points, from 38% at baseline to 42% following the intervention. The control group improved by one percentage point, from 39% at baseline to 40% at trial's conclusion. The adjusted difference between the intervention and control groups was 8% (95% confidence interval 1%, 15%). Intervention effectiveness did not decrease with time.Conclusion:For common pediatric outpatient conditions, a point-of-care evidence-based prescription writer and decision support system was associated with significant improvements in prescribing practices.
Highlights
Health information technologies offer substantial promise to improve health care [1]
At the time the study was conceived, approximately 75% of otitis media cases were being treated with antibiotics, and we considered a clinically significant goal to be that of lowering this proportion to 60%—an absolute change of 15%
The intervention period lasted for a total of 50 mo at PCC and for 18 mo at Skagit Pediatrics (SP), during which 57,319 and 33,127 visits were made for pediatric care at the two sites, respectively. (The length of the intervention was longer at PCC since the network was already in place at PCC while it had to be constructed at SP.) At the two sites combined there
Summary
Health information technologies offer substantial promise to improve health care [1]. These improvements could come about as a result of embedding software within a medical record system that alerts clinicians to evidence that is relevant to the care they are providing Such a system might deliver a pop-up reminder that informs a clinician about a potential prescribing error, or that the prescription ordered is not supported by recent evidence. Systematic reviews of randomized controlled trials evaluating the benefits of such systems have shown that computerized feedback and reminder systems can improve clinician behavior Much of this evidence comes from academic clinics caring for adults, and there is not very much evidence available on children or from community-based, nonacademic clinical practices. The primary outcome in the trial was the change in proportion of prescriptions dispensed in accordance with evidence, over the course of the trial
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