Introduction
Antibiotic resistance is a growing problem worldwide and a major public health threat [1]. In primary care, the majority of antibiotic overuse stems from inappropriate prescribing for acute respiratory infections (ARI), leading to increasing antimicrobial resistance. Nearly half of all visits for ARI for which antibiotics are rarely indicated result in a prescription for an antibiotic, with increasing use of broad spectrum antibiotics [2]. In recent years, numerous strategies to increase adherence to clinical practice guidelines for judicious antibiotic prescribing have had varying degrees of success [3], [4], [5]. Multi-faceted interventions combining physician, patient and public education have been most successful in reducing antibiotic prescribing for inappropriate indications [3], although much room for improvement remains [2], [6], [7].
Electronic clinical decision support systems (CDSS) which provide clinicians with patient-specific assessments or recommendations at the time and location of decision making have been increasingly promoted as a means to change physician behavior [8], [9]. Such tools have been shown to be particularly effective for increasing adherence to guideline based care [10]. A few previous studies have piloted the use of CDSS to improve clinician adherence to guidelines for appropriate antibiotic prescribing for ARI. Results of these studies suggest that, when used, these tools may positively impact prescribing, yet low rates of adoption by providers have limited further assessment of their efficacy [11], [12].
The Reducing Inappropriate Prescribing of Antibiotics by Primary Care Clinicians (ABX-TRIP) demonstration project is designed to assess the impact of a CDSS on antibiotic prescribing for ARI in primary care practices using a multi-method intervention to facilitate CDSS adoption. The purpose of this report is to describe use of the CDSS, as well as facilitators and barriers to its adoption, during the first year of the 15-month intervention.