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

Robert L Davis1, Jeffrey Wright, Francie Chalmers

  • 1Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, United States of America. robert.l.davis@kp.org

Plos Clinical Trials
|May 26, 2007
PubMed

Insights

An electronic prescribing system improved pediatric prescribing for common conditions. This evidence-based tool enhanced provider practices, showing significant improvements in prescription accuracy for various pediatric illnesses.

Area of Science:

  • Pediatric Healthcare Informatics
  • Clinical Decision Support Systems
  • Evidence-Based Medicine Implementation

Background:

  • Previous studies demonstrated that electronic prescription systems improve pediatric prescribing for otitis media.
  • The need to assess the broader applicability of such systems for other common pediatric conditions remains.
  • Optimizing prescribing practices in pediatric outpatient settings is crucial for patient outcomes and healthcare efficiency.

Purpose of the Study:

  • To evaluate the effectiveness of a point-of-care, evidence-based electronic prescription writer and decision support system.
  • To determine if this system improves prescribing behavior for a range of common pediatric conditions beyond otitis media.
  • To assess the impact on the proportion of prescriptions dispensed in accordance with evidence-based guidelines.

Main Methods:

  • A cluster randomized controlled trial was conducted across a teaching clinic/practice site and a primary care pediatric clinic.
  • The intervention involved an evidence-based message system delivering real-time prescribing feedback for acute otitis media, allergic rhinitis, sinusitis, constipation, pharyngitis, croup, urticaria, and bronchiolitis.
  • Prescribing practices were assessed by measuring the proportion of prescriptions dispensed in accordance with evidence.

Main Results:

  • The intervention group showed a 4-percentage-point improvement in evidence-based prescribing (38% to 42%).
  • The control group improved by 1 percentage point (39% to 40%), with an adjusted difference favoring the intervention group by 8%.
  • The effectiveness of the intervention remained consistent over time.

Conclusions:

  • A point-of-care evidence-based prescription writer and decision support system significantly improved prescribing practices for common pediatric outpatient conditions.
  • The findings support the integration of such systems into routine pediatric care to enhance evidence-based prescribing.
  • This approach demonstrates a scalable method for improving the quality of care in pediatric practice.
Abstract

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