PDAs Help Doctors Cut Excessive Antibiotics

Tools that guide doctors' decisions can reduce excessive use of antibiotics.

Antibiotics cant treat the cold or the flu. Prescribed unwisely, they make bacteria harder to kill and make infections harder to treat. Still, about half the antibiotic prescriptions written in doctors offices are useless, or worse. But tools that guide doctors decisions can reduce excessive use of antibiotics, according to a study published Tuesday in the Journal of the American Medical Association.

The study compared antibiotic prescriptions in eighteen rural communities. In some communities, a public education campaign urged patients not to get unnecessary antibiotics and doctors were given both paper-based and PDA tools to show whether antibiotics are recommended. Other communities received only the public education campaign or no intervention at all. The only significant decrease in antibiotic use occurred in the communities where doctors had the tools. Furthermore, the more doctors used these tools, the more inappropriate use of the antibiotics declined.

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Physicians are generally considered to be slow to change their prescribing habits, even in the face of new clinical data and guidelines. But Matthew Samore, the University of Utah informaticist and epidemiologist who led the study, thinks clinical decision support tools could be more effective. (He is quick to point out that the study did not go on long enough to show how long the change would last; antibiotic prescriptions were tracked from January 2002 to September 2003.)

A separate study published last month found that a clinical decision support systems could change behavior. In that study, doctors entered patient prescriptions into a system that generated alerts when a drug could prove dangerous to a particular patient.

But Samore is particularly interested in decision support tools for physician education. Unlike clinical guidelines, support tools make recommendations for specific individuals based on multiple sources of data. "Doctors, or anybody, dont like things that are annoying or perceived to be unnecessary," he said. To make the tools more acceptable, he imagines that tool use could be mandatory for a certain number of patient visits and then made optional. Doctors should also be rewarded for participating, perhaps through continuing education credits.

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