Christakis DA et al. 2001 "A randomized controlled trial of point-of-care evidence to improve the antibiotic prescribing practices for otitis media in children."
Reference
Christakis DA, Zimmerman FJ, Wright JA, et al. A randomized controlled trial of point-of-care evidence to improve the antibiotic prescribing practices for otitis media in children. Pediatrics 2001;107(2):e15.
Abstract
"Context. Prescribing practices for otitis media are not consistent with current evidence-based recommendations.
Objective. To determine whether point-of-care evidence delivery regarding the use and duration of antibiotics for otitis media decreases the duration of therapy from 10 days and decreases the frequency of prescriptions written.
Design. Randomized, controlled trial.
Setting. Primary care pediatric clinic affiliated with university training program.
Intervention. A point-of-care evidence-based message system presenting real time evidence to providers based on their prescribing practice for otitis media.
Main Outcome Measures. Proportion of prescriptions for otitis media that were for <10 days and frequency with which antibiotics were prescribed.
Results. Intervention providers had a 34% greater reduction in the proportion of time they prescribed antibiotics for <10 days. Intervention providers were less likely to prescribe antibiotics than were control providers.
Conclusions. A point-of-care information system integrated into outpatient pediatric care can significantly influence provider behavior for a common condition."
Objective. To determine whether point-of-care evidence delivery regarding the use and duration of antibiotics for otitis media decreases the duration of therapy from 10 days and decreases the frequency of prescriptions written.
Design. Randomized, controlled trial.
Setting. Primary care pediatric clinic affiliated with university training program.
Intervention. A point-of-care evidence-based message system presenting real time evidence to providers based on their prescribing practice for otitis media.
Main Outcome Measures. Proportion of prescriptions for otitis media that were for <10 days and frequency with which antibiotics were prescribed.
Results. Intervention providers had a 34% greater reduction in the proportion of time they prescribed antibiotics for <10 days. Intervention providers were less likely to prescribe antibiotics than were control providers.
Conclusions. A point-of-care information system integrated into outpatient pediatric care can significantly influence provider behavior for a common condition."
Objective
"To determine whether point-of-care evidence delivery regarding the use and duration of antibiotics for otitis media decreases the duration of therapy from 10 days and decreases the frequency of prescriptions written."
Tools Used
Type Clinic
Primary care
Type Specific
Pediatrics
Size
Large
Geography
Urban
Other Information
The study took place at the Pediatric Care Center (PCC) at the University of Washington. The center has 29 resident physicians, two nurse practitioners, and seven attending physicians.
Type of Health IT
Decision support system
Type of Health IT Functions
The system functions as follows: "to prescribe a medication for any given patient, a provider selects a patient's name within the system and clicks on a treatment icon. Providers can then select a medication and an indication as well as a dosage and duration. The system prints out a copy of the prescription, which providers sign." When providers selected an antibiotic medication, they were shown a popup screen with a five-line summary of evidence for the drug. Following the evidence, the providers could do the following: 1) see more information; 2) see the abstract of the articles from which the summaries were derived; 3) see the articles themselves that had been scanned; or 4) have the references emailed to them automatically.
Context or other IT in place
There was a pre-existing patient flow manager system developed by one of the authors in place at the study site. The "system includes a daily electronic roster of scheduled patients as well as their vital signs and height and weight, which are entered by
Workflow-Related Findings
"During the baseline period, 50.7% of all prescriptions for otitis media were written for a duration of <10 days. After the intervention, this average increased to 69.7%"
"Providers in the intervention arm had a 44% change in the frequency with which they prescribed antibiotics for <10 days, whereas providers in the control arm had a 10% change."
Study Design
Randomized controlled trial (RCT)
Study Participants
The study participants included 38 providers.