Trial to Reduce Antibiotic Use in A Primary Care PBRN

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DESCRIPTION (provided by applicant): Background: Upper respiratory tract infections (URIs) are the number one reason for prescribing antibiotics in the United States. Most antibiotic prescribing for URIs is done in primary care and much antibiotic prescribing for URIs is inappropriate. Inappropriate antibiotic prescribing exposes patients to unnecessary medication, increases the prevalence of antibiotic-resistant bacteria, and increases medical costs. Interventions are needed to reduce inappropriate antibiotic prescribing for URIs in primary care. The PBRN: The Brigham and Women's Primary Care Practice-Based Research Network (BWPC-PBRN) consists of 12 ambulatory clinics with 95 physicians who serve a socioeconomically and ethnically diverse patient population. The BWPC-PBRN had 237,530 total patient visits and had 17,443 visits for URIs in 2002. BWPC clinics are linked organizationally and electronically with e-mail and the use of a common electronic medical record that allows linkage of diagnostic, prescribing, and other clinical data. Research Plan: We propose to develop and evaluate a novel electronic medical record-based URI-care template in the BWPC-PBRN through two specific aims. Specific aim 1 is to design and implement an electronic medical record-based template for the care of patients with URIs in primary care practice, the URI Smart Set. The URI Smart Set will include easy documentation in the form of checkboxes for symptoms and physical findings; automatic importation of patients' problems, allergies, and medications; decision-support for the treatment of sinusitis, pharyngitis, and acute bronchitis; printable patient handouts about URIs, self-care, and antibiotics; and access to relevant medical literature. Specific aim 2 is to test the implementation of the URI Smart Set in a randomized, controlled trial. Following a baseline period, 18 practices within the BWPC-PBRN will be randomized to control status or to the use of the URI Smart Set. The primary outcome will be antibiotic prescribing for URIs during a six-month period. Secondary outcomes will be the appropriateness of antibiotic prescribing, 30-day repeat visits, antibiotic costs, and barriers to the use of the URI Smart Set. Future Directions: Longer term goals of this research include optimization of the usability and functionality of the URI Smart Set; serving as a prototype for standardizing documentation for other clinical problems in primary care; rapidly identifying patients who potentially meet criteria for inclusion in future trials of therapy in URI care; and providing real-time surveillance for bioterrorist attacks or the emergence of novel respiratory pathogens, such as severe acute respiratory syndrome (SARS).