Clinical decision support systems and antibiotic use
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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.
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.
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.
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.
KeywordsAntibacterials Antibiotics Anti-infectives Antimicrobials Clinical decision support Decision support system
Nada Shebl is partly funded by the UK Overseas Research Award Scheme.
- 9.House of Lords Select Committee on Science and Technology-Seventh Report. Resistance to Antibiotics and Other Antimicrobial Agents, 1998. [http://www.parliament.the-stationery- office.co.uk/pa/ld199798/ldselect/ldsctech/081vii/st0702.htm] (January 4th 2006).Google Scholar
- 13.Mullet CJ, Thomas JG. Database-driven computerized antibiotic decision support: novel use of expert antibiotic susceptibility rules embedded in a pathogen antibiotic logic matrix. In: Musen M, editor. AMIA 2003 Symposium-Biomedical and Health Informatics: From Foundations to Applications [Proceedings]. Washington, DC: American Medical Informatics Association; 2003. p. 480–3.Google Scholar
- 17.Morell R, Wasilauskas B, Winslow R. Personal computer-based expert system for quality assurance of antimicrobial therapy. Am J Hosp Pharm 1993;50:2067–73.Google Scholar
- 19.Warner H Jr, Blue SR, Sorenson D, Reimer L, Li L, Nelson M, Barton M, et al. New computer-based tools for empiric antibiotic decision support. In: Masys DR, editor. AMIA 1997 Annual Fall Symposium [Proceedings]. Washington, DC: American Medical Informatics Association; 1997. p. 238–42.Google Scholar
- 24.Smith F. Research methods in pharmacy practice. London: Pharmaceutical Press; 2002.Google Scholar
- 25.Bowling A. Research methods in health-Investigating health and health services. 2nd ed. Buckingham: Open University Press; 2002.Google Scholar
- 38.Walton RT, Harvery E, Dovey S, Freemantle N. Computerised advice on drug dosage to improve prescribing practice. The Cochrane Library 2006;1:1–22.Google Scholar
- 39.Bowling A, Ebrahim S. Handbook of health research methods: investigation, measurement and analysis. England: Open University Press; 2006.Google Scholar