Impact of an electronic best-practice advisory in combination with prescriber education on antibiotic prescribing for ambulatory adults with acute, uncomplicated bronchitis within a large integrated health system
Impact of an electronic best-practice advisory in combination with prescriber education on antibiotic prescribing for ambulatory adults with acute, uncomplicated bronchitis within a large integrated health system
复制标题
DOI：
10.1017/ice.2019.295
复制
发表时间：
2019-12-01
影响因子：
4.5
通讯作者：
Brummitt, Charles F.
中科院分区：
文献类型：
--
作者：
Pagels, Courtney M.;Dilworth, Thomas J.;Brummitt, Charles F.
目的：确定被动、处方者指导、电子最佳实践咨询与处方者教育对大型卫生系统中门诊成人急性、无并发症支气管炎抗生素处方率的影响。设计图：这项研究是一项准实验，检查了2016年1月1日至2018年12月31日期间患有急性支气管炎的非卧床成人的抗生素处方。该干预措施于2016年12月在急诊科和紧急护理诊所实施，随后于2017年9月在门诊诊所实施。设置：整个卫生系统的门诊设置，包括15个急诊科，>30个紧急护理诊所和>150个门诊诊所。参与者：纳入了所有从研究中心就诊并出院的初步诊断为急性支气管炎的成年人。干预措施：一个被动的，处方导向的，最佳实践咨询治疗急性支气管炎的电子健康记录和一个可选的，在线教育模块有关急性支气管炎。结果如下：该研究包括81，975名在干预前初步诊断为急性支气管炎的非卧床成人（19.8% >65岁; 61.9%女性）和89，571名干预后非卧床成人（16.5% >65岁; 61.1%女性）。抗生素处方率从干预前的60.8%（81,975例患者中的49,877例）下降到干预后的51.4%（89,571例患者中的46,018例）（绝对差异为9.4%; P <0.001）。减少最多的是急诊室。结论：电子最佳实践咨询与处方者教育相结合，与急性支气管炎成人抗生素处方的统计学显著减少相关。未来的研究应纳入患者教育，并解决处方者报告的适当抗生素处方的障碍。
Objective: To determine the impact of a passive, prescriber-directed, electronic best-practice advisory coupled with prescriber education on the rate of antibiotic prescribing for acute, uncomplicated bronchitis in ambulatory adults across a large health system. Design: This study was a quasi-experiment examining antibiotic prescribing for ambulatory adults with acute bronchitis from January 1, 2016 through December 31, 2018. The intervention was implemented in December 2016 for emergency departments and urgent care clinics followed by ambulatory clinics in September 2017. Setting: Outpatient settings across a health system, including 15 emergency departments, >30 urgent care clinics, and >150 ambulatory clinics. Participants: All adults with a primary diagnosis of acute bronchitis who were seen and discharged from a study site were included. Interventions: A passive, prescriber-directed, best-practice advisory for treatment of acute bronchitis in the electronic health record and an optional, online education module regarding acute bronchitis. Results: The study included 81,975 ambulatory adults with a primary diagnosis of acute bronchitis during the preintervention period (19.8% >65 years of age; 61.9% female) and 89,571 ambulatory adults during the postintervention period (16.5% >65 years of age; 61.1% female). Antibiotic prescribing rates decreased from 60.8% (49,877 of 81,975 patients) preintervention to 51.4% (46,018 of 89,571 patients) postintervention (absolute difference, 9.4%; P < .001). The largest reduction occurred in the emergency departments. Conclusions: An electronic best practice advisory combined with prescriber education was associated with a statistically significant reduction in antibiotic prescribing for adults with acute bronchitis. Future studies should incorporate patient education and address prescriber-reported barriers to appropriate antibiotic prescribing.