Shebl NA et al. 2007 "Clinical decision support systems and antibiotic use."

Shebl NA, Franklin BD, Barber N. Clinical decision support systems and antibiotic use. Pharm World Sci 2007;29(4):342-349.
"Aim: To review and appraise randomised controlled trials (RCT) and 'before and after' studies published on clinical decision support systems (CDSS) used to support the use of antibiotics. Methods: A literature search. was carried out in October 2006 using MEDLINE including Medical Subject Heading (MeSH) terms (1966-2006), EMBASE (Excerpta Medica, 1980-2006) and International Pharmaceutical Abstracts (IPA, 1970-2006) using the combinations of the following terms: (Decision support systems) or (CDSS) AND (antibiotics) or (anti-infectives) or (antibacterials) or (antimicrobials). Only English language papers were selected. Editorials, letters and case reports/series were excluded. The reference sections of all retrieved articles were also searched for any further relevant articles. Results: Forty articles were identified. Five RCT and six 'before and after' studies were retrieved. In the RCTs, three studies used computer-based CDSS, one paper-based CDSS and one a combination of both. Two studies were conducted in primary care and three within secondary care. The primary outcomes for each study were different and only three studies were significant in the favour of the use of CDSS. 'Before and after' studies were used where RCT were not feasible. One 'before and after' study was excluded because it did not include any control group. The remaining five included historical control groups and evaluated the use of computer-based CDSS within secondary care. Their primary outcomes also varied but all concluded significant, benefits of CDSS. Only three of ten studies were conducted outside the USA; one in Switzerland and two in Australia. Conclusion CDSS could be a powerful tool to improve clinical care and patient outcomes. It presents a promising future for optimising antibiotic use. However, it is difficult to generalise as most studies were conducted in the United States. Although RCT are the 'gold standard' in research, they may not be feasible to conduct. Realising that different study designs answer different questions would allow researchers to choose the most appropriate study design to evaluate CDSS in a specified setting."
"To summarise the relevant literature available regarding the use of CDSS and antibiotics[, by] review[ing], summaris[ing] and apprais[ing] randomised controlled trials (RCT) and 'before and after' trials published on CDSS used to support the use of antibiotics, and ... identify[ing] gaps in the existing literature."
not applicable
Type of Health IT
Decision support system
Type of Health IT Functions
"No a priori definition was used for CDSS so as not to limit the articles retrieved to a particular definition of CDSS." Articles were included that used the term "decision support systems."
Workflow-Related Findings
"Three of the four studies showed a significant improvement in the process of patient care when CDSS was implemented and used, while the paper-based CDSS showed a non-significant reduction in the time to modify intravenous antibiotic therapy."
All of the five before and after studies showed positive impacts of CDSS use on the process of care, such as the rates of optimal antibiotic timing, the number of antibiotic doses, and the rates of subtherapeutic dosing.
"Physicians' and patients' attitudes toward CDSS may also dictate its potential failure or success within a system. Only one study used a questionnaire to determine clinicians' satisfaction with the use of CDSS or the effect it had on their practice. Clinician satisfaction was not a primary aim of any of the studies."
Study Design
Systematic literature review
Study Participants
"The search yielded 56 research papers. Only 28 were relevant...The reference sections of all retrieved papers were manually searched and an additional 12 relevant papers identified. A total of 40 papers were therefore identified," of which five were RCTs and six were 'before and after' studies. One 'before and after' study was excluded because it did not have a control group; therefore, 10 studies were summarized.