Clinical decision support systems and antibiotic use.

Shebl, N.A., Franklin, B.D. and Barber, N. (2007) Clinical decision support systems and antibiotic use. Pharmacy World and Science, 29 (4). pp. 342-349. 10.1007/s11096-007-9113-3.

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DOI: 10.1007/s11096-007-9113-3

Abstract

Aim 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. Methods 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. Results 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. Conclusion 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.

Item Type:Article
Additional Information:Full text available electronically from the School of Pharmacy Library.
Uncontrolled Keywords:Antibacterials - Antibiotics - Anti-infectives - Antimicrobials - Clinical decision support - Decision support system
Departments, units and centres:Department of Practice and Policy > Department of Practice and Policy
ID Code:1751
Journal or Publication Title:Pharmacy World and Science
Deposited By:Library Staff
Deposited On:13 Aug 2010 09:53
Last Modified:20 Oct 2011 10:44

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