Providing information to patients about acute respiratory tract infections (ARIs), either through printed or online materials, decreased the percentage of adolescents and adults prescribed antibiotics for acute bronchitis, according to research published online ahead of print by JAMA Internal Medicine.
For the study, investigators conducted a three-group cluster randomized study at 33 primary care practices in an integrated health care system in central Pennsylvania. In addition to 11 control sites, 11 practices received printed decision support (PDS) in which educational brochures were given to patients with cough illnesses as part of routine care; a poster displaying the clinical algorithm for distinguishing between acute bronchitis and pneumonia was also placed in exam rooms.
At the remaining 11 practices, computer-assisted decision support (CDS) was provided. When triage nurses entered “cough” into patient record, an alert prompted them to give the patient educational brochure.
At the test sites, the percentage of patients prescribed antibiotics for uncomplicated acute bronchitis. In the practices with PDS intervention, prescriptions fell from 80% to 68.3%; at the CDS intervention sites, the drop was from 74% to 60.7%. The only rise was seen at the control sites, where the number rose slightly from 72.5% to 74.3%, according to the study results.
“In this cluster randomized trial comparing the effectiveness of different implementation strategies for delivering clinical algorithm-based decision support for acute cough illness, we found that printed and computer-assisted approaches were equally effective at improving antibiotic treatment of uncomplicated acute bronchitis,” the authors concluded. “In aggregate, these findings support the wider dissemination and use of this clinical algorithm to help reduce the overuse of antibiotics for acute bronchitis in primary care.”
