在门诊儿科治疗皮肤和软组织感染的默认抗生素订单持续时间:一个集群随机试验
Kali A Broussard1, Juan D Chaparro2, Guliz Erdem3
1Division of Pediatrics, Franciscan Missionaries of Our Lady Health System, Lafayette, Los Angeles, USA.
Journal of the Pediatric Infectious Diseases Society
|December 12, 2024
概括
一项针对皮肤感染的电子健康记录订单面板的研究发现,它们并没有显著减少长时间的抗生素处方. 然而,当使用时,面板确实导致了针对皮肤和软组织感染的指导方针一致的抗生素持续时间.
科学领域:
- 传染性疾病 传染性疾病
- 医疗信息学 医疗信息学
- 儿科初级护理 儿科初级护理
背景情况:
- 对不复杂的皮肤和软组织感染 (SSTI) 处方抗生素经常超过指南推的持续时间.
- 减少长期使用抗生素对于抗菌药物管理至关重要.
研究的目的:
- 评估电子健康记录 (EHR) 默认持续时间订单小组在减少长时间的SSTI抗生素处方方面的有效性.
- 评估决策支持对儿科初级保健中抗生素处方模式的影响.
主要方法:
- 一个集群随机试验将SSTI订单小组与默认持续时间与在14家儿科诊所没有决策支持的控制小组进行了比较.
- 分析了23个月的处方前实施和12个月的后实施 (2020年1月至2022年12月) 的处方数据.
- 长时间的抗生素处方是根据特定的SSTI类型和超过5或7天的持续时间来定义的.
主要成果:
- 与对照组相比,干预小组没有显著降低长期抗生素处方的总体率.
- 在干预组中,长期处方率从63.8%降至54.6%,而在对照组中,从70.0%降至54.9%.
- 通过干预小组订购的处方药的长期使用率较低 (或0.18),尽管服用量有限 (29.4%的符合条件的遭遇).
结论:
- 具有默认持续时间的EHR订单小组没有证明SSTI长期抗生素处方的总体减少.
- 当使用干预小组时,抗生素处方更有可能符合指南.
- 需要进一步开发自动默认持续时间选择,以有效减少长时间的抗生素处方.
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