Research Paper: Use of a Personal Digital Assistant for Managing Antibiotic Prescribing for Outpatient Respiratory Tract Infections in Rural Communities

OBJECTIVE To assess the acceptability and usage of a standalone personal digital assistant (PDA)-based clinical decision-support system (CDSS) for the diagnosis and management of acute respiratory tract infections (RTIs) in the outpatient setting. DESIGN Observational study performed as part of a larger randomized trial in six rural communities in Utah and Idaho from January 2002 to March 2004. Ninety-nine primary care providers received a PDA-based CDSS for use at the point-of-care, and were asked to use the tool with at least 200 patients with suspected RTIs. MEASUREMENTS Clinical data were collected electronically from the devices at periodic intervals. Providers also completed an exit questionnaire at the end of the study period. RESULTS Providers logged 14,393 cases using the CDSS, the majority of which (n=7624; 53%) were from family practitioners. Overall adherence with CDSS recommendations for the five most common diagnoses (pharyngitis, otitis media, sinusitis, bronchitis, and upper respiratory tract infection) was 82%. When antibiotics were prescribed (53% of cases), adherence with the CDSS-recommended antibiotic was high (76%). By logistic regression analysis, the odds of adherence with CDSS recommendations increased significantly with each ten cases completed (P=0.001). Questionnaire respondents believed the CDSS was easy to use, and most (44/65; 68%) did not believe it increased their encounter time with patients, regardless of prior experience with PDAs. CONCLUSION A standalone PDA-based CDSS for acute RTIs used at the point-of-care can encourage better outpatient antimicrobial prescribing practices and easily gather a rich set of clinical data.

[1]  Richard N. Shiffman,et al.  Model Formulation: A Design Model for Computer-based Guideline Implementation Based on Information Management Services , 1999, J. Am. Medical Informatics Assoc..

[2]  Paul C. Tang,et al.  Research Paper: Measuring the Effects of Reminders for Outpatient Influenza Immunizations at the Point of Clinical Opportunity , 1999, J. Am. Medical Informatics Assoc..

[3]  A. Potts,et al.  Computerized physician order entry and medication errors in a pediatric critical care unit. , 2004, Pediatrics.

[4]  Matthew H Samore,et al.  Clinical decision support and appropriateness of antimicrobial prescribing: a randomized trial. , 2005, JAMA.

[5]  R M Centor,et al.  The Diagnosis of Strep Throat in Adults in the Emergency Room , 1981, Medical decision making : an international journal of the Society for Medical Decision Making.

[6]  Yang Lei,et al.  Implementation of hospital computerized physician order entry systems in a rural state: feasibility and financial impact. , 2004 .

[7]  Gilad J. Kuperman,et al.  Synthesis of Research Paper: A Consensus Statement on Considerations for a Successful CPOE Implementation , 2003, J. Am. Medical Informatics Assoc..

[8]  H. Mcdonald,et al.  Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. , 2005, JAMA.

[9]  J Marc Overhage,et al.  Can computer-generated evidence-based care suggestions enhance evidence-based management of asthma and chronic obstructive pulmonary disease? A randomized, controlled trial. , 2005, Health services research.

[10]  A Bogusevicius,et al.  Prospective randomised trial of computer-aided diagnosis and contrast radiography in acute small bowel obstruction. , 2002, The European journal of surgery = Acta chirurgica.

[11]  D. Bates,et al.  Improving response to critical laboratory results with automation: results of a randomized controlled trial. , 1999, Journal of the American Medical Informatics Association : JAMIA.

[12]  Robert S. Dittus,et al.  Trends in antibiotic prescribing for adults in the United States—1995 to 2002 , 2005, Journal of General Internal Medicine.

[13]  D. Bates,et al.  Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. , 2003, Archives of internal medicine.

[14]  D. Malone,et al.  Excessive antibiotic use for acute respiratory infections in the United States. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[15]  H. Lehmann,et al.  Clinical Decision Support Systems (cdsss) Have Been Hailed for Their Potential to Reduce Medical Errors Clinical Decision Support Systems for the Practice of Evidence-based Medicine , 2022 .

[16]  Matthew H Samore,et al.  A multifaceted intervention to improve antimicrobial prescribing for upper respiratory tract infections in a small rural community. , 2005, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[17]  R. Haynes,et al.  Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. , 1998, JAMA.

[18]  P. Albertsen.  Guided medication dosing for inpatients with renal insufficiency. , 2002, The Journal of urology.

[19]  Sandra L De Groote,et al.  The use of personal digital assistants in the health sciences: results of a survey. , 2004, Journal of the Medical Library Association : JMLA.

[20]  Inger,et al.  A prediction rule to identify low-risk patients with community-acquired pneumonia. , 1997, The New England journal of medicine.

[21]  R. Gonzales,et al.  The relationship between the clinical features of pharyngitis and the sensitivity of a rapid antigen test: evidence of spectrum bias. , 2001, Annals of emergency medicine.

[22]  John Morrissey,et al.  Capital crunch eats away at IT. Annual survey shows lack of funding among obstacles slowing adoption of computerized physician order entry, other projects. , 2004, Modern healthcare.

[23]  Harlan M Krumholz,et al.  A randomized outpatient trial of a decision-support information technology tool. , 2005, Archives of internal medicine.

[24]  T. Payne.  Computer decision support systems. , 2000, Chest.

[25]  Ralph Gonzales,et al.  Changing Use of Antibiotics in Community-Based Outpatient Practice, 19911999 , 2003, Annals of Internal Medicine.

[26]  J. Bartlett,et al.  Principles of appropriate antibiotic use for acute pharyngitis in adults: background. , 2001, Annals of internal medicine.

[27]  W G Henderson,et al.  Improving residents' compliance with standards of ambulatory care: results from the VA Cooperative Study on Computerized Reminders. , 2000, JAMA.

[28]  E. Balas,et al.  Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success , 2005, BMJ : British Medical Journal.

[29]  Elizabeth G Baxley,et al.  Rural-urban differences in visits to primary care physicians. , 2002, Family medicine.

[30]  S. Schoenbaum,et al.  Information technologies: when will they make it into physicians' black bags? , 2004, MedGenMed : Medscape general medicine.

[31]  D. Bates,et al.  Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. , 1998, JAMA.

[32]  J P Ornato,et al.  Use of the Acute Cardiac Ischemia Time-Insensitive Predictive Instrument (ACI-TIPI) To Assist with Triage of Patients with Chest Pain or Other Symptoms Suggestive of Acute Cardiac Ischemia: A Multicenter, Controlled Clinical Trial , 1998, Annals of Internal Medicine.