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An electronic chart prompt to decrease proprietary antibiotic prescription to self-pay patients.

Steven L Bernstein1, David Whitaker, Jonathan Winograd

  • 1Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA. sbernste@montefiore.org

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
|March 3, 2005
PubMed
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A clinical decision support system reduced expensive antibiotic prescriptions for uninsured patients in the emergency department (ED). This system displayed insurance status before prescribing, leading to significant cost savings for self-pay patients.

Area of Science:

  • Health Informatics
  • Clinical Decision Support Systems
  • Pharmacoeconomics

Background:

  • Emergency physicians may prescribe costly proprietary antibiotics without knowledge of patient insurance status.
  • This can lead to financial burdens for patients unable to afford these medications.
  • An intervention was needed to address this disparity in the emergency department (ED).

Purpose of the Study:

  • To develop and evaluate a clinical decision support system (CDSS).
  • The CDSS aimed to display patient insurance status prior to antibiotic prescription.
  • The goal was to reduce the prescription of expensive proprietary antibiotics for self-pay patients.

Main Methods:

  • A 26-week before-and-after trial was conducted in an urban ED.

Related Experiment Videos

  • The study involved 61 prescribers and focused on antibiotic prescriptions for adult patients.
  • A CDSS integrated into the electronic prescribing software prompted prescribers with patient insurance status.

    • Main Results:

    • The rate of proprietary antibiotic prescriptions for self-pay patients decreased from 26.6% to 20.7% after the intervention.
    • This reduction was statistically significant (p = 0.03).
    • Significant reductions were also observed for respiratory and urinary tract infections (p = 0.03).

    Conclusions:

    • Integrated clinical decision support systems can effectively reduce proprietary antibiotic prescribing for self-pay patients in the ED.
    • This intervention demonstrates a practical approach to improving medication affordability.
    • The findings support the use of technology to enhance equitable healthcare access.