An electronic chart prompt to decrease proprietary antibiotic prescription to self-pay patients
An electronic chart prompt to decrease proprietary antibiotic prescription to self-pay patients
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DOI：
10.1197/j.aem.2004.09.021
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发表时间：
2005-03-01
影响因子：
4.4
通讯作者：
Brennan, JA
中科院分区：
文献类型：
--
作者：
Bernstein, SL;Whitaker, D;Brennan, JA
目的：急诊医生不知道患者的保险状况，可能会给负担不起的患者开昂贵的专有抗生素。这项研究的目的是开发一个临床决策支持系统，在为门诊情况开具处方之前显示患者的保险状态。方法：这是一项在城市急诊科(ED)进行的为期26周的“前后”试验，每年有78,000人次就诊，治疗医疗服务不足的人群。61名处方医生，包括主治医生、住院医生和医生助理参与其中。所有18岁以上接受抗生素处方的急症室出院病人均符合资格。电子ED图表链接到处方编写软件，其中包括74种抗生素的菜单。该系统经过编程，当急诊医生访问处方菜单时，会出现一个显示保险状态的提示。处方者还接受了教育干预。主要结果衡量标准是处方医生减少向自助付费患者开出专有抗生素处方的百分比。使用SPSS10.0(SPSS Inc.，芝加哥，伊利诺伊州)对数据进行聚类技术分析。结果：594张处方中，158张(26.6%)为专有抗菌药物。干预后，自费患者共收到抗菌药物处方564张，其中中成药117张，占20.7%。按处方者分析，专有抗生素处方率下降有统计学意义(p=0.03，x(2)检验)。呼吸道或尿路感染患者的专有抗生素处方也有统计上的显著减少(p=0.03)。结论：将临床决策支持系统集成到处方书写程序中，可以减少急诊室自费患者使用专有抗生素的次数。
Objectives: Emergency physicians unaware of patients' insurance status may prescribe expensive proprietary antibiotics for patients who cannot afford them. The objective of this study was to develop a clinical decision support system to display patient insurance status before prescription writing for outpatient conditions. Methods: This was a 26-week "before-and-after" trial at an urban emergency department (ED) with 78,000 visits/year treating a medically underserved population. Sixty-one prescribers, including attending physicians, residents, and physician assistants, participated. All patients older than 18 years of age discharged from the ED receiving antibiotic prescriptions were eligible. The electronic ED chart is linked to prescription-writing software, which includes a menu of 74 antibiotics. The system was programmed so that when an emergency physician accessed the prescription menu, a prompt appeared displaying insurance status. Prescribers also received educational interventions. The main outcome measure was the percentage of prescribers who reduced their prescription writing of proprietary antibiotics to selfpay patients. Data were analyzed with cluster techniques using SPSS 10.0 (SPSS Inc., Chicago, IL). Results: Of 594 prescriptions written for self-pay patients before prompt insertion, 158 (26.6%) were for proprietary antibiotics. After the intervention, self-pay patients received 564 antibiotic prescriptions, of which 117 (20.7%) were for proprietary drugs. Analyzed by prescriber, the reduction in the prescription rate for proprietary antibiotics was statistically significant (p = 0.03, x(2) test). Patients with respiratory or urinary infections also had a statistically significant reduction in proprietary antibiotic prescription (p = 0.03). Conclusions: A clinical decision support system, integrated into a prescription-writing program, can decrease the prescription of proprietary antibiotics for self-pay patients in the ED.