Impact of E-prescribing protocols on antimicrobial prescribing for common infections in Greece: an interrupted time...

We aimed to evaluate the effect of the implementation of electronic-prescribing protocols for infectious diseases on outpatient antimicrobial prescribing patterns in Greece.

In 2018-2019, in the context of policies to control antimicrobial use in Greece, electronic-prescribing protocols for acute pharyngitis, community-acquired pneumonia (CAP), acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and urinary tract infection (UTI) were introduced. We conducted a retrospective nationwide Interrupted Time Series analysis of monthly outpatient antimicrobial prescription counts overall and for targeted infectious syndromes during the preintervention and postintervention periods. Data were extracted from the official nationwide electronic prescription database covering July 2017 to December 2021.

Overall reductions in median monthly antimicrobial prescription counts between the pre- and postintervention periods were 71.3% (95% CI: -78.5% to -56.4%) for pharyngitis, 90.0% (95% CI: -94.3% to -85.3%) for CAP, 92.6% (95% CI: -94.1% to -87.9%) for AECOPD, 85.8% (95% CI: -86.6% to -83.0%) for UTI. Despite these syndrome-specific reductions, the median monthly number of total outpatient antimicrobial prescriptions did not decrease (417 633 vs. 424 592 prescriptions per month). Before the intervention, the protocol-targeted syndromes collectively accounted for a median of 27.6% of total antimicrobial prescriptions per month, whereas 'other nonprotocol conditions' represented a median of 72.4%. After implementation, these proportions shifted dramatically to a median of 4.5% and 95.5% respectively (p < 0.001 for both changes), indicating a shift in diagnostic coding associated with antimicrobial prescribing.

Although the protocols were designed to promote targeted antimicrobial use, their complex implementation may have inadvertently encouraged suboptimal prescribing practices. Improper coding and inconsistent antimicrobial prescribing data hinder antimicrobial stewardship efforts and should prompt a national health policy action plan.