Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave Suite 820, Charleston, SC 29425, USA.
Int J Med Inform. 2012 Aug;81(8):521-6. doi: 10.1016/j.ijmedinf.2012.03.002. Epub 2012 Apr 5.
Overuse of antibiotics for acute respiratory infections (ARIs) in primary care is an established risk factor for worsening antimicrobial resistance. The "Reducing Inappropriate Prescribing of Antibiotics by Primary Care Clinicians" study is assessing the impact of a clinical decision support system (CDSS) on antibiotic prescribing for ARIs using a multimethod intervention to facilitate CDSS adoption. The purpose of this report is to describe use of the CDSS, as well as facilitators and barriers to its adoption, during the first year of the 15-month intervention.
Between January 1, 2010 and December 31, 2010, 39 providers in 9 practices in US states participated in this study. Quarterly EHR based audit and feedback, practice site visits for academic detailing, performance review and CDSS training, and "best-practice" dissemination during two meetings of study participants were used to facilitate CDSS adoption. Mixed methods were used to evaluate adoption of the CDSS. Using data extracted from the EHR, CDSS use for ARI was calculated. To determine facilitators and barriers of CDSS adoption, semi-structured group interviews were conducted with providers and staff at each practice.
During the first year of implementation, the ABX-TRIP CDSS was used 14,086 times for ARI encounters. Overall, practice use of the CDSS during ARI encounters ranged from 39.4% to 77.2%. Median use of the CDSS for adult patients was 58.2% and 68.6% for pediatric patients. Key factors associated with CDSS adoption include the perception by providers that it assists with decision making and stimulates patient discussions, engagement of non-physician staff and an iterative CDSS development process.
Adoption of a custom designed CDSS in the first year of implementation is promising. Successful implementation of such technology requires a focus not only on the technological solution itself, but on its integration with the entire clinical workplace.
在初级保健中过度使用抗生素治疗急性呼吸道感染（ARI）是导致抗菌药物耐药性恶化的既定危险因素。“减少初级保健临床医生抗生素处方的不适当使用”研究正在评估使用临床决策支持系统（CDSS）对 ARI 抗生素处方的影响，该研究采用多方法干预措施来促进 CDSS 的采用。本报告的目的是描述在 15 个月干预的第一年中 CDSS 的使用情况，以及采用 CDSS 的促进因素和障碍。
2010 年 1 月 1 日至 2010 年 12 月 31 日，美国 9 个实践中的 39 名提供者参加了这项研究。每季度使用基于电子健康记录（EHR）的审核和反馈、到实践地点进行学术详细信息介绍、绩效审查和 CDSS 培训，以及在研究参与者的两次会议期间进行“最佳实践”传播，以促进 CDSS 的采用。采用混合方法评估 CDSS 的采用情况。使用从 EHR 中提取的数据，计算 ARI 就诊时 CDSS 的使用情况。为了确定采用 CDSS 的促进因素和障碍，对每个实践中的提供者和工作人员进行了半结构化小组访谈。
在实施的第一年中，ABX-TRIP CDSS 用于 14086 次 ARI 就诊。总体而言，在 ARI 就诊期间，该实践使用 CDSS 的范围为 39.4%至 77.2%。成人患者使用 CDSS 的中位数为 58.2%，儿科患者为 68.6%。与 CDSS 采用相关的关键因素包括提供者认为它有助于决策制定和刺激患者讨论、非医师人员的参与以及迭代 CDSS 开发过程。
在实施的第一年中，采用定制设计的 CDSS 是有希望的。这种技术的成功实施不仅需要关注技术解决方案本身，还需要关注其与整个临床工作场所的整合。
