PDA program cuts use of antibiotics

Choosing the right antibiotic for a bacterial infection is important. As important, though, is not taking antibiotics for conditions they don't fight, which leads to increased antibiotic resistance and development of superbugs, deemed a public health crisis.

Now Utah researchers have shown that use of a clinical decision support system and patient education reduces overall use of antimicrobials for colds, bronchitis and sinusitis, among other respiratory conditions that antibiotics don't help. The tool they used is a program on a PDA that helps a doctor determine if a respiratory infection requires an antibiotic and, if so, which one and even how much.

The study, published today in the Journal of the American Medical Association, shows that providing physicians with the PDA-program support helped reduce the number of antibiotics being used for respiratory infections. And when one was needed, it helped doctors pick the right antibiotic.

Anything that increases the likelihood of using the right treatment is good news, say Dr. Kim Bateman, medical director of HealthInsight and a family practice physician in Ephraim, and Dr. Matthew H. Samore, University of Utah professor of internal medicine, adjunct professor of medical informatics and a physician practicing at both the U. and Salt Lake VA hospitals.

They conducted the research in six Utah and six Idaho rural communities, using six other communities not involved in the training as controls. The three-year randomized trial included 407,460 inhabitants and 334 primary care clinicians. "It was a superb example of Utah and Intermountain West physicians, academicians, medical technologists and others working together to do research that helps the public," says Samore.

In half the communities, education campaigns aimed solely at the public were used.

In the PDA-program-assisted communities, prescription rates decreased 10 percent, while they went up slightly in the other communities. In a post-intervention phase of study, in cases where antibiotic use was classed as "never indicated," their use dropped 32 percent. Communitywide antimicrobial usage was measured using pharmacy data, while diagnosis-specific antimicrobial use was compared by chart review.

"The reason this study's important is it shows you can't do it by just talking to patients," who sometimes demand antibiotics when they feel ill, Bateman says. Samore calls it a culture of expectation. "It's a habit that needs to be broken somehow."