Default Antibiotic Order Durations for Skin and Soft Tissue Infections in Outpatient Pediatrics: A Cluster Randomized Trial

被引：0
作者：
Broussard, Kali A. [1 ]
Chaparro, Juan D. [2 ,3 ]
Erdem, Guliz [3 ,4 ]
Abdel-Rasoul, Mahmoud [5 ]
Stevens, Jack [3 ,6 ]
Watson, Joshua R. [3 ,7 ]
机构：
[1] Franciscan Missionaries Our Lady Hlth Syst, Div Pediat, Los Angeles, CA USA
[2] Nationwide Childrens Hosp, Dept Pediat, Div Clin Informat & Pediat Infect Dis, Columbus, OH USA
[3] Ohio State Univ, Coll Med, 700 Childrens Dr, Columbus, OH 43205 USA
[4] Nationwide Childrens Hosp, Dept Pediat, Div Pediat Infect Dis, Columbus, OH USA
[5] Ohio State Univ, Ctr Biostat, Columbus, OH USA
[6] Nationwide Childrens Hosp, Ctr Biobehav Hlth, Ctr Clin Excellence, 700 Childrens Dr, Columbus, OH 43205 USA
[7] Nationwide Childrens Hosp, Ctr Clin Excellence, Dept Pediat, Div Pediat Infect Dis, 700 Childrens Dr, Columbus, OH 43205 USA
来源：
JOURNAL OF THE PEDIATRIC INFECTIOUS DISEASES SOCIETY | 2024年 / 14卷 / 01期
关键词：
antibiotic treatment; behavioral economics; order panel; short-course therapy; skin and soft tissue infection;
D O I：
10.1093/jpids/piae127
中图分类号：
R51 [传染病];
学科分类号：
100401 ;
摘要：
Background: Antibiotic durations for uncomplicated skin/soft tissue infections (SSTI) often exceed the guideline-recommended 5-7 days. We assessed the effectiveness of a default duration order panel in the Electronic Health Record (EHR) to reduce long prescriptions. Methods: Cluster randomized trial of a SSTI order panel with default antibiotic durations (implemented 12/2021), compared to a control panel (no decision support) in 14 pediatric primary care clinics. We assessed long prescription rates from 23 months before to 12 months after order panel implementation (1/2020-12/2022). Antibiotic duration was considered long if >5 days for cellulitis or drained abscess, or >7 days for undrained abscess, impetigo, or other SSTI. Results: We included 1123 and 511 encounters in intervention and control clinics, respectively. In a piecewise generalized linear model, long prescription rate decreased from 63.8% to 54.6% (absolute difference, -9.2%) in the intervention group and from 70.0% to 54.9% (absolute difference, -15.1%) in the control group. The relative change in trajectories from pre-panel to post-panel periods did not differ significantly between intervention and control groups (P = .488). Although used in only 29.4% of eligible encounters, intervention panel use had lower odds of long prescription compared to all other prescriptions (OR 0.18). Conclusion: We did not detect an overall impact of an order panel with default durations in reducing long antibiotic prescriptions for SSTIs. When ordered from the intervention panel, prescriptions were usually guideline-concordant. Effective strategies to make choosing a default duration more automatic are necessary to further reduce long prescriptions.
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页数：6
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