Evaluation of an Algorithm to Reduce Antibiotic Prescribing for Acute Bronchitis

NCT00981994 | Completed

• 1 other identifier: 5R01CI000611
• Study Type: interventional
• Target: 3,300
• Locations: 0 countries
• Sites: N/A

Brief Summary

Inappropriate use of antibiotics to treat patients with acute bronchitis is a significant factor contributing to the selection of antimicrobial drug resistant pathogens, which threaten the effectiveness of available therapies to treat common community-acquired bacterial infections. A key factor driving overuse of antibiotics is inaccurate estimation of pneumonia risk among patients with acute cough illnesses. This study will use a cluster randomized trial design within the Geisinger Health System's integrated clinic network to measure the efficacy of an algorithm driven clinical decision support tool to safely reduce the frequency of unnecessary antibiotic prescriptions for adult patients with lower respiratory tract infections.

Conditions

Acute Respiratory Tract Infection

Keywords

respiratory infection; antimicrobial drugs; decision support; Adult patients

Outcome Measures

Primary Outcomes (1)

• Proportion of visits to primary care clinic associated with antibiotic prescriptions

  30 days

Study Arms (3)

Electronic Decision Support

EXPERIMENTAL

Use of electronic decision support to provide the treatment algorithm for providers managing patients with acute respiratory infections.

Behavioral: Decision Support for ARI Management

Paper Decision Support

EXPERIMENTAL

Use of paper based tools to provide the treatment algorithm for providers managing patients with acute respiratory infections.

Behavioral: Decision Support for ARI Management

Usual Care

NO INTERVENTION

Usual Care

Interventions

Decision Support for ARI Management BEHAVIORAL

Use of history and physical examination findings to estimate probability of pneumonia in patients with acute respiratory infections and thereby guide treatment decisions

Electronic Decision Support; Paper Decision Support

Eligibility Criteria

• Age: 16 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Primary care practice sites within the Geisinger Health System

You may not qualify if:

• Sites with \< 1000 visits per year for acute respiratory infection

Sponsors & Collaborators

• University of Pennsylvania: lead
• University of California, San Francisco: collaborator
• Geisinger Clinic: collaborator

Related Publications (1)

• Gonzales R, Anderer T, McCulloch CE, Maselli JH, Bloom FJ Jr, Graf TR, Stahl M, Yefko M, Molecavage J, Metlay JP. A cluster randomized trial of decision support strategies for reducing antibiotic use in acute bronchitis. JAMA Intern Med. 2013 Feb 25;173(4):267-73. doi: 10.1001/jamainternmed.2013.1589.

  PMID: 23319069 DERIVED

MeSH Terms

Conditions

Respiratory Tract Infections

Condition Hierarchy (Ancestors)

Infections; Respiratory Tract Diseases

Study Officials

• Joshua P Metlay, MD, PhD

  University of Pennsylvania

  PRINCIPAL INVESTIGATOR

• Ralph Gonzales, MD,MS

  University of California, San Francisco

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: September 14, 2009
• First Posted: September 22, 2009
• Study Start: October 1, 2009
• Primary Completion: May 1, 2011
• Study Completion: September 1, 2012
• Last Updated: November 28, 2016

Record last verified: 2016-11