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Impact of an electronic best-practice advisory in combination with prescriber education on antibiotic prescribing for ambulatory adults with acute, uncomplicated bronchitis within a large integrated health system

Published online by Cambridge University Press:  21 October 2019

Courtney M. Pagels ,
Thomas J. Dilworth Open the ORCID record for Thomas J. Dilworth [Opens in a new window] ,
Lynne Fehrenbacher ,
Maharaj Singh  and
Charles F. Brummitt
Courtney M. Pagels
Affiliation:
AdvocateAuroraHealth, Milwaukee, Wisconsin
Thomas J. Dilworth*
Affiliation:
AdvocateAuroraHealth, Milwaukee, Wisconsin
Lynne Fehrenbacher
Affiliation:
Concordia University Wisconsin School of Pharmacy, Mequon, Wisconsin
Maharaj Singh
Affiliation:
Marquette University, School of Dentistry, Milwaukee, Wisconsin
Charles F. Brummitt
Affiliation:
AdvocateAuroraHealth, Milwaukee, Wisconsin
*
Author for correspondence: Thomas J. Dilworth, Email: [email protected]
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Abstract

Objective:

To determine the impact of a passive, prescriber-directed, electronic best-practice advisory coupled with prescriber education on the rate of antibiotic prescribing for acute, uncomplicated bronchitis in ambulatory adults across a large health system.

Design:

This study was a quasi-experiment examining antibiotic prescribing for ambulatory adults with acute bronchitis from January 1, 2016 through December 31, 2018. The intervention was implemented in December 2016 for emergency departments and urgent care clinics followed by ambulatory clinics in September 2017.

Setting:

Outpatient settings across a health system, including 15 emergency departments, >30 urgent care clinics, and >150 ambulatory clinics.

Participants:

All adults with a primary diagnosis of acute bronchitis who were seen and discharged from a study site were included.

Interventions:

A passive, prescriber-directed, best-practice advisory for treatment of acute bronchitis in the electronic health record and an optional, online education module regarding acute bronchitis.

Results:

The study included 81,975 ambulatory adults with a primary diagnosis of acute bronchitis during the preintervention period (19.8% >65 years of age; 61.9% female) and 89,571 ambulatory adults during the postintervention period (16.5% >65 years of age; 61.1% female). Antibiotic prescribing rates decreased from 60.8% (49,877 of 81,975 patients) preintervention to 51.4% (46,018 of 89,571 patients) postintervention (absolute difference, 9.4%; P < .001). The largest reduction occurred in the emergency departments.

Conclusions:

An electronic best practice advisory combined with prescriber education was associated with a statistically significant reduction in antibiotic prescribing for adults with acute bronchitis. Future studies should incorporate patient education and address prescriber-reported barriers to appropriate antibiotic prescribing.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 12 , December 2019 , pp. 1348 - 1355
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION: This work was presented in part as poster no. 179 at IDWeek 2018 on October 4, 2018, in San Francisco, California.

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