A cluster randomized clinical trial to improve prescribing patterns in ambulatory pediatrics.

OBJECTIVES

Having shown previously that an electronic prescription writer and decision support system improved pediatric prescribing behavior for otitis media in an academic clinic setting, we assessed whether point-of-care delivery of evidence could demonstrate similar effects for a wide range of other common pediatric conditions.

DESIGN

Cluster randomized controlled trial.

SETTING

A teaching clinic/clinical practice site and a primary care pediatric clinic serving a rural and semi-urban patient mix.

PARTICIPANTS

A total of 36 providers at the teaching clinic/practice site and eight providers at the private primary pediatric clinic.

INTERVENTION: An evidence-based message system that presented real-time evidence to providers based on prescribing practices for acute otitis media, allergic rhinitis, sinusitis, constipation, pharyngitis, croup, urticaria, and bronchiolitis.

OUTCOME MEASURES: The proportion of prescriptions dispensed in accordance with evidence.

RESULTS

The proportion of prescriptions dispensed in accordance with evidence improved four percentage points, from 38% at baseline to 42% following the intervention. The control group improved by one percentage point, from 39% at baseline to 40% at trial's conclusion. The adjusted difference between the intervention and control groups was 8% (95% confidence interval 1%, 15%). Intervention effectiveness did not decrease with time.

CONCLUSION

For common pediatric outpatient conditions, a point-of-care evidence-based prescription writer and decision support system was associated with significant improvements in prescribing practices.