Trial to Reduce Antibiotic Use in A Primary Care PBRN

描述(申请人提供)：背景：在美国，上呼吸道感染(URI)是开抗生素的头号原因。大多数URI的抗生素处方是在初级保健中进行的，而且许多URI的抗生素处方是不合适的。不适当的抗生素处方使患者接触到不必要的药物，增加了抗生素耐药性细菌的流行，并增加了医疗成本。需要采取干预措施，以减少初级保健中URI的不适当抗生素处方。 PBRN：布里格姆和妇女初级保健实践研究网络(BWPC-PBRN)由12个门诊诊所和95名医生组成，为不同社会经济和种族的患者群体提供服务。2002年，BWPC-PBRN总共有237,530次病人就诊，有17,443次URI就诊。BWPC诊所通过电子邮件和公共电子病历的使用，以组织和电子方式连接在一起，从而实现诊断、处方和其他临床数据的链接。 研究计划：我们建议通过两个具体目标在BWPC-PBRN中开发和评估一个新的基于电子病历的URI-CARE模板。具体目标1是设计和实现一个基于电子病历的模板，用于护理初级保健实践中的URI患者，即URI Smart Set。URI Smart Set将包括以复选框形式显示症状和物理结果的简单文档；自动输入患者的问题、过敏和药物；鼻窦炎、咽炎和急性支气管炎的治疗决策支持；有关URI、自我护理和抗生素的可打印患者手册；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 Smart Set的实施情况。在一个基准期之后，BWPC-PBRN内的18个实践将被随机分配到控制状态或使用URI智能集。主要结果将是在六个月内为URI开抗生素处方。次要结果将是抗生素处方的适当性、30天的重复访问、抗生素成本以及使用URI Smart Set的障碍。 未来方向：这项研究的长期目标包括优化URI Smart Set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；快速识别可能符合纳入未来URI护理治疗试验的标准的患者；以及对生物恐怖袭击或严重急性呼吸综合征(SARS)等新型呼吸道病原体的出现进行实时监测。

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).