计算机化模板对儿童和青少年急性呼吸道感染抗生素处方的影响。
Impact of a computerized template on antibiotic prescribing for acute respiratory infections in children and adolescents.
作者信息
Bourgeois Fabienne C, Linder Jeffrey, Johnson Sarah A, Co John Patrick T, Fiskio Julie, Ferris Timothy G
机构信息
Children's Hospital Boston, Boston, MA 02115, USA.
出版信息
Clin Pediatr (Phila). 2010 Oct;49(10):976-83. doi: 10.1177/0009922810373649. Epub 2010 Aug 19.
BACKGROUND
Computerized decision support (CDS) can potentially improve patient safety and guideline adherence. The authors developed an acute respiratory illness interactive template (ARI-IT) within an electronic health record (EHR) to manage pediatric ARIs and assessed the impact on antibiotic prescribing.
METHODS
They randomized 12 practices either to receive the ARI-IT or to the control group. Antibiotic rates among all eligible ARI diagnoses were compared among control and intervention ARI visits, controlling for clustering by clinician.
RESULTS
There was no difference in total antibiotic prescriptions between control and intervention clinics. Use of the ARI-IT significantly reduced antibiotic prescriptions (31.7% vs 39.9%; P = .02) and use of macrolides (6.2% vs 9.5%; P = .02) among visits compared with those eligible visits where it was not used.
CONCLUSION
Use of the CDS reduced antibiotic prescribing and macrolide prescriptions among children with an ARI. Nonetheless, the low overall use resulted in an ineffective intervention.
背景
计算机化决策支持（CDS）有可能提高患者安全性并促进指南遵循。作者在电子健康记录（EHR）中开发了一个急性呼吸道疾病交互式模板（ARI-IT）来管理儿科急性呼吸道感染（ARI），并评估其对抗生素处方的影响。
方法
他们将12家医疗机构随机分为接受ARI-IT组或对照组。在对照和干预的ARI就诊中，比较所有符合条件的ARI诊断中的抗生素使用率，并对临床医生的聚类情况进行控制。
结果
对照诊所和干预诊所之间的总抗生素处方量没有差异。与未使用ARI-IT的符合条件就诊相比，使用ARI-IT显著减少了就诊中的抗生素处方（31.7%对39.9%；P = 0.02）和大环内酯类药物的使用（6.2%对9.5%；P = 0.02）。
结论
CDS的使用减少了ARI患儿的抗生素处方和大环内酯类药物处方。尽管如此，总体使用率较低导致干预效果不佳。
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