Robert L Davis, Jeffrey Wright, Francie Chalmers, Linda Levenson, Julie C Brown, Paula Lozano, Dimitri A Christakis
{"title":"一项改善门诊儿科处方模式的随机临床试验。","authors":"Robert L Davis, Jeffrey Wright, Francie Chalmers, Linda Levenson, Julie C Brown, Paula Lozano, Dimitri A Christakis","doi":"10.1371/journal.pctr.0020025","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Having shown previously that an electronic prescription writer and decision support system improved pediatric prescribing behavior for otitis media in an academic clinic setting, we assessed whether point-of-care delivery of evidence could demonstrate similar effects for a wide range of other common pediatric conditions.</p><p><strong>Design: </strong>Cluster randomized controlled trial.</p><p><strong>Setting: </strong>A teaching clinic/clinical practice site and a primary care pediatric clinic serving a rural and semi-urban patient mix.</p><p><strong>Participants: </strong>A total of 36 providers at the teaching clinic/practice site and eight providers at the private primary pediatric clinic.</p><p><strong>Intervention: </strong>An evidence-based message system that presented real-time evidence to providers based on prescribing practices for acute otitis media, allergic rhinitis, sinusitis, constipation, pharyngitis, croup, urticaria, and bronchiolitis.</p><p><strong>Outcome measures: </strong>The proportion of prescriptions dispensed in accordance with evidence.</p><p><strong>Results: </strong>The proportion of prescriptions dispensed in accordance with evidence improved four percentage points, from 38% at baseline to 42% following the intervention. The control group improved by one percentage point, from 39% at baseline to 40% at trial's conclusion. The adjusted difference between the intervention and control groups was 8% (95% confidence interval 1%, 15%). Intervention effectiveness did not decrease with time.</p><p><strong>Conclusion: </strong>For common pediatric outpatient conditions, a point-of-care evidence-based prescription writer and decision support system was associated with significant improvements in prescribing practices.</p>","PeriodicalId":87416,"journal":{"name":"PLoS clinical trials","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2007-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1371/journal.pctr.0020025","citationCount":"43","resultStr":"{\"title\":\"A cluster randomized clinical trial to improve prescribing patterns in ambulatory pediatrics.\",\"authors\":\"Robert L Davis, Jeffrey Wright, Francie Chalmers, Linda Levenson, Julie C Brown, Paula Lozano, Dimitri A Christakis\",\"doi\":\"10.1371/journal.pctr.0020025\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>Having shown previously that an electronic prescription writer and decision support system improved pediatric prescribing behavior for otitis media in an academic clinic setting, we assessed whether point-of-care delivery of evidence could demonstrate similar effects for a wide range of other common pediatric conditions.</p><p><strong>Design: </strong>Cluster randomized controlled trial.</p><p><strong>Setting: </strong>A teaching clinic/clinical practice site and a primary care pediatric clinic serving a rural and semi-urban patient mix.</p><p><strong>Participants: </strong>A total of 36 providers at the teaching clinic/practice site and eight providers at the private primary pediatric clinic.</p><p><strong>Intervention: </strong>An evidence-based message system that presented real-time evidence to providers based on prescribing practices for acute otitis media, allergic rhinitis, sinusitis, constipation, pharyngitis, croup, urticaria, and bronchiolitis.</p><p><strong>Outcome measures: </strong>The proportion of prescriptions dispensed in accordance with evidence.</p><p><strong>Results: </strong>The proportion of prescriptions dispensed in accordance with evidence improved four percentage points, from 38% at baseline to 42% following the intervention. The control group improved by one percentage point, from 39% at baseline to 40% at trial's conclusion. The adjusted difference between the intervention and control groups was 8% (95% confidence interval 1%, 15%). Intervention effectiveness did not decrease with time.</p><p><strong>Conclusion: </strong>For common pediatric outpatient conditions, a point-of-care evidence-based prescription writer and decision support system was associated with significant improvements in prescribing practices.</p>\",\"PeriodicalId\":87416,\"journal\":{\"name\":\"PLoS clinical trials\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2007-05-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1371/journal.pctr.0020025\",\"citationCount\":\"43\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"PLoS clinical trials\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1371/journal.pctr.0020025\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"PLoS clinical trials","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1371/journal.pctr.0020025","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
A cluster randomized clinical trial to improve prescribing patterns in ambulatory pediatrics.
Objectives: Having shown previously that an electronic prescription writer and decision support system improved pediatric prescribing behavior for otitis media in an academic clinic setting, we assessed whether point-of-care delivery of evidence could demonstrate similar effects for a wide range of other common pediatric conditions.
Design: Cluster randomized controlled trial.
Setting: A teaching clinic/clinical practice site and a primary care pediatric clinic serving a rural and semi-urban patient mix.
Participants: A total of 36 providers at the teaching clinic/practice site and eight providers at the private primary pediatric clinic.
Intervention: An evidence-based message system that presented real-time evidence to providers based on prescribing practices for acute otitis media, allergic rhinitis, sinusitis, constipation, pharyngitis, croup, urticaria, and bronchiolitis.
Outcome measures: The proportion of prescriptions dispensed in accordance with evidence.
Results: The proportion of prescriptions dispensed in accordance with evidence improved four percentage points, from 38% at baseline to 42% following the intervention. The control group improved by one percentage point, from 39% at baseline to 40% at trial's conclusion. The adjusted difference between the intervention and control groups was 8% (95% confidence interval 1%, 15%). Intervention effectiveness did not decrease with time.
Conclusion: For common pediatric outpatient conditions, a point-of-care evidence-based prescription writer and decision support system was associated with significant improvements in prescribing practices.