Effectiveness of Clinical Pathway Pop-Up Window Insertion in Computer-Based Prescription System for Antibiotic Stewardship in Acute Diarrhea.

BACKGROUND

Acute diarrhea is highly prevalent in Thailand, and inappropriate antibiotic use remains common. The effectiveness of a clinical pathway pop-up integrated into a computerized prescription system for antibiotic stewardship has not been previously evaluated.

MATERIALS AND

METHODS

We conducted a quasi-experimental study following implementation of a clinical pathway pop-up on 21 December 2021. Outpatient records from Srinagarind Hospital and two nearby primary care units were reviewed from November 2021 to January 2022. Patients were divided into pre- and post-intervention groups. Factors associated with antibiotic prescribing and appropriate antibiotic management were analyzed.

RESULTS

A total of 460 patients were included (230 per group); 26.7% were male, with a mean age of 34.8, and 82% of patients were treated in the emergency department. Antibiotics were prescribed to 30.9% of patients in both pre-intervention and post-intervention groups (P>0.999). Rational antibiotic use was 76.5% before and 75.7% after the intervention (P=0.827). Segmented linear regression analysis demonstrated no significant change in prescription rates or appropriate antibiotic management before and after the intervention. Care provided by a resident physician was independently associated with lower odds of appropriate antibiotic management (adjusted odds ratio, 0.38; 95% confidence interval, 0.15-0.85; P=0.020).

CONCLUSION

The implementation of a clinical pathway pop-up window in a computerized prescription system did not significantly reduce inappropriate antibiotic use or improve rational prescribing in patients with acute diarrhea. Resident physicians as primary care providers were independently associated with inappropriate antibiotic management.

TRIAL REGISTRATION: Thai Clinical Trials Registry: TCTR20210420002.