Trial to Reduce Antibiotic Use in A Primary Care PBRN

描述（由申请人提供）：背景：上呼吸道感染（URI）是美国处方抗生素的头号原因。 大多数针对URI的抗生素处方是在初级保健中进行的，并且许多针对URI的抗生素处方是不合适的。 不适当的抗生素处方使患者暴露于不必要的药物，增加了耐药性细菌的流行，并增加了医疗费用。 需要采取干预措施，以减少初级保健中不适当的抗生素处方。 PBRN：布里格姆和妇女的初级保健实践为基础的研究网络（BWPC-PBRN）由12个门诊诊所与95名医生谁服务的社会经济和种族多样化的患者群体。 2002年，BWPC-PBRN共有237 530名患者就诊，17 443人因URI就诊。 BWPC诊所通过电子邮件和使用共同的电子病历进行组织和电子联系，从而可以将诊断、处方和其他临床数据联系起来。 研究计划：我们建议通过两个具体目标，在BWPC-PBRN中开发和评估一种新的基于电子病历的URI护理模板。 具体目标1是设计和实现一个基于电子病历的模板，用于在初级保健实践中护理URI患者，URI智能集。 URI智能集将包括以症状和身体检查结果复选框形式的简单文档;自动导入患者的问题，过敏和药物;鼻窦炎，咽炎和急性支气管炎治疗的决策支持;关于URI，自我护理和抗生素的可打印患者讲义;以及访问相关医学文献。 具体目标2是在随机对照试验中测试URI智能集的实施。 在基线期之后，BWPC-PBRN中的18个实践将被随机分配到对照状态或URI智能集的使用。 主要结果将是6个月期间针对URI的抗生素处方。 次要结果将是抗生素处方的适当性、30天重复访视、抗生素费用和使用URI Smart Set的障碍。 未来方向：这项研究的长期目标包括优化URI智能集的可用性和功能;作为初级保健中其他临床问题的标准化文档的原型;快速识别可能符合URI护理治疗未来试验标准的患者;并对生物恐怖袭击或新型呼吸道病原体（如严重急性呼吸道综合征（SARS））的出现提供实时监测。

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).