Insertion of a Clinical Pathway Pop-Up Window into a Computer-Based Prescription System: A Method to Promote Antibiotic Stewardship in Upper Respiratory Tract Infection
Outpatient antibiotics are most frequently prescribed for upper respiratory tract infection (URI); however, most such prescriptions are inappropriate. We aimed to determine the effect of an electronic clinical pathway on the rates of overall and rational prescription of antibiotics in patients with...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-12-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/10/12/1479 |
| _version_ | 1797506852415602688 |
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| author | Wantin Sribenjalux Nattawat Larbsida Sittichai Khamsai Benjaphol Panyapornsakul Phitphiboon Deawtrakulchai Atibordee Meesing |
| author_facet | Wantin Sribenjalux Nattawat Larbsida Sittichai Khamsai Benjaphol Panyapornsakul Phitphiboon Deawtrakulchai Atibordee Meesing |
| author_sort | Wantin Sribenjalux |
| collection | DOAJ |
| description | Outpatient antibiotics are most frequently prescribed for upper respiratory tract infection (URI); however, most such prescriptions are inappropriate. We aimed to determine the effect of an electronic clinical pathway on the rates of overall and rational prescription of antibiotics in patients with URI. A pilot quasi-experimental study was conducted in a university hospital and two of its nearby primary care units (PCU) in northeast Thailand from June to September 2020. Clinical pathway pop-up windows were inserted into the hospital’s computer-based prescription system. Care providers were required to check the appropriate boxes before they were able to prescribe amoxicillin or co-amoxiclav. We examined a total of 675 visits to the outpatient department due to URI at three points in time: pre-intervention, immediately post-intervention, and 6 weeks post-intervention. Patients in the latter group tended to be younger and visits were more likely to be general practitioner-related and to the student PCU than in the other two groups. In addition, the rate of antibiotic prescription was significantly lower at 6 weeks after intervention than at either of the other time periods (32.0% vs 53.8% pre-intervention and 46.2% immediately post-intervention; <i>p</i> < 0.001), and the proportion of rational antibiotic prescriptions increased significantly after implementation. Antibiotic prescription rates were lower at the community primary care unit and higher when the physician was a resident or a family doctor. The deployment of an electronic clinical pathway reduced the rate of unnecessary antibiotic prescriptions. The effect was greater at 6 weeks post-implementation. However, discrepancy of patients’ baseline characteristics may have skewed the findings. |
| first_indexed | 2024-03-10T04:39:19Z |
| format | Article |
| id | doaj.art-303e4e6f193a4f95b8cc7d3e4be06172 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-10T04:39:19Z |
| publishDate | 2021-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-303e4e6f193a4f95b8cc7d3e4be061722023-11-23T03:30:29ZengMDPI AGAntibiotics2079-63822021-12-011012147910.3390/antibiotics10121479Insertion of a Clinical Pathway Pop-Up Window into a Computer-Based Prescription System: A Method to Promote Antibiotic Stewardship in Upper Respiratory Tract InfectionWantin Sribenjalux0Nattawat Larbsida1Sittichai Khamsai2Benjaphol Panyapornsakul3Phitphiboon Deawtrakulchai4Atibordee Meesing5Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, ThailandDepartment of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, ThailandDepartment of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, ThailandDepartment of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, ThailandDepartment of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, ThailandDepartment of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, ThailandOutpatient antibiotics are most frequently prescribed for upper respiratory tract infection (URI); however, most such prescriptions are inappropriate. We aimed to determine the effect of an electronic clinical pathway on the rates of overall and rational prescription of antibiotics in patients with URI. A pilot quasi-experimental study was conducted in a university hospital and two of its nearby primary care units (PCU) in northeast Thailand from June to September 2020. Clinical pathway pop-up windows were inserted into the hospital’s computer-based prescription system. Care providers were required to check the appropriate boxes before they were able to prescribe amoxicillin or co-amoxiclav. We examined a total of 675 visits to the outpatient department due to URI at three points in time: pre-intervention, immediately post-intervention, and 6 weeks post-intervention. Patients in the latter group tended to be younger and visits were more likely to be general practitioner-related and to the student PCU than in the other two groups. In addition, the rate of antibiotic prescription was significantly lower at 6 weeks after intervention than at either of the other time periods (32.0% vs 53.8% pre-intervention and 46.2% immediately post-intervention; <i>p</i> < 0.001), and the proportion of rational antibiotic prescriptions increased significantly after implementation. Antibiotic prescription rates were lower at the community primary care unit and higher when the physician was a resident or a family doctor. The deployment of an electronic clinical pathway reduced the rate of unnecessary antibiotic prescriptions. The effect was greater at 6 weeks post-implementation. However, discrepancy of patients’ baseline characteristics may have skewed the findings.https://www.mdpi.com/2079-6382/10/12/1479antibiotic stewardshipantibiotic prescriptionclinical pathwaypop-up windowupper respiratory tract infection |
| spellingShingle | Wantin Sribenjalux Nattawat Larbsida Sittichai Khamsai Benjaphol Panyapornsakul Phitphiboon Deawtrakulchai Atibordee Meesing Insertion of a Clinical Pathway Pop-Up Window into a Computer-Based Prescription System: A Method to Promote Antibiotic Stewardship in Upper Respiratory Tract Infection Antibiotics antibiotic stewardship antibiotic prescription clinical pathway pop-up window upper respiratory tract infection |
| title | Insertion of a Clinical Pathway Pop-Up Window into a Computer-Based Prescription System: A Method to Promote Antibiotic Stewardship in Upper Respiratory Tract Infection |
| title_full | Insertion of a Clinical Pathway Pop-Up Window into a Computer-Based Prescription System: A Method to Promote Antibiotic Stewardship in Upper Respiratory Tract Infection |
| title_fullStr | Insertion of a Clinical Pathway Pop-Up Window into a Computer-Based Prescription System: A Method to Promote Antibiotic Stewardship in Upper Respiratory Tract Infection |
| title_full_unstemmed | Insertion of a Clinical Pathway Pop-Up Window into a Computer-Based Prescription System: A Method to Promote Antibiotic Stewardship in Upper Respiratory Tract Infection |
| title_short | Insertion of a Clinical Pathway Pop-Up Window into a Computer-Based Prescription System: A Method to Promote Antibiotic Stewardship in Upper Respiratory Tract Infection |
| title_sort | insertion of a clinical pathway pop up window into a computer based prescription system a method to promote antibiotic stewardship in upper respiratory tract infection |
| topic | antibiotic stewardship antibiotic prescription clinical pathway pop-up window upper respiratory tract infection |
| url | https://www.mdpi.com/2079-6382/10/12/1479 |
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