Promoting Judicious Antibiotic Use: Results of an Outpatient-Based Randomized EMR-generated intervention study

Abstract

BackgroundAccording to the CDC, up to 50% of antibiotic (abx) prescriptions are not needed or inappropriate–often used too long or too broadly. Repercussions include multidrug resistance, adverse reactions, and increased incidence and mortality from Clostridium difficile. A JAMA study demonstrated that IDSA guidelines can influence abx prescribing patterns positively for genitourinary infections.In this electronic age, interventions include providing direct access to guidelines through a Best Practice Alert (BPA) embedded within electronic medical records (EMR). This assists clinicians when recommending abx. The study’s goal was to improve compliance with guidelines when treating uncomplicated UTIs at outpatient sites by using targeted education and Clinical Decision Support (CDS).MethodsOutpatient sites were randomized with matching into two groups: BPA intervention group (IG) (71 sites; 4,555 visits) or control group (CG) (56 sites; 2,078 visits). The BPA listed the appropriate abx regimens according to guidelines. A second modification presented all providers with a list of abx options including dosage and frequency. The effects of two CDS interventions were assessed for one year.ResultsResults indicate the IG improved in BPA abx compliance over the CG. Figure 1 shows compliance with BPA recommended antibiotics among the IG increased from 17% to 23% during Q1 2014-Q2 2017 compared with a 0% increase in the CG (P <.0001). However, overall IDSA recommended compliance did not significantly increase: IG -2% vs CG 1% (P = .26). UTI patients of providers who saw the BPA alert were 1.9 times (CI: 1.7, 2.3) times more likely to receive recommended abx compared with the CG.ConclusionThis randomized control study provides promising data that the use of CDS, specifically BPAs embedded within EMRs, can be used effectively to assist and encourage compliance with guidelines. Next steps include: continuing to educate providers on best practices, consider including more abx options in BPA to reduce errors in prescribing and improve overall compliance, and implementing similar CDS interventions for upper respiratory infections and other infections.Disclosures All authors: No reported disclosures.