Use of a Personal Digital Assistant for Managing Antibiotic Prescribing for Outpatient Respiratory Tract Infections in Rural Communities
- Michael A Rubin,
- Kim Bateman,
- Sharon Donnelly,
- Gregory J Stoddard,
- Kurt Stevenson,
- Reed M Gardner,
- Matthew H Samore
- Affiliation of the authors: Departments of Medical Informatics (MAR, RMG, MHS) and Internal Medicine (MAR, GJS, MHS), University of Utah, Salt Lake City, UT; HealthInsight, Salt Lake City, UT (KB, SD); Qualis Health, Boise, ID (KS) (now at Department of Internal Medicine, Ohio State University College of Medicine, Columbus, OH)
- Correspondence and reprints: Michael A. Rubin, MD PhD, Department of Internal Medicine and, Department of Medical Informatics, University of Utah School of Medicine, 300 North 1900 East, Room AC-230A, Salt Lake City, UT 84132. e-mail: <Michael.Rubin{at}hsc.utah.edu>
- Received 1 December 2005
- Accepted 1 August 2006
Abstract
Objective To assess the acceptability and usage of a standalone personal digital assistant (PDA)-based clinical decision-support system (CDSS) for the diagnosis and management of acute respiratory tract infections (RTIs) in the outpatient setting.
Design Observational study performed as part of a larger randomized trial in six rural communities in Utah and Idaho from January 2002 to March 2004. Ninety-nine primary care providers received a PDA-based CDSS for use at the point-of-care, and were asked to use the tool with at least 200 patients with suspected RTIs.
Measurements Clinical data were collected electronically from the devices at periodic intervals. Providers also completed an exit questionnaire at the end of the study period.
Results Providers logged 14,393 cases using the CDSS, the majority of which (n=7624; 53%) were from family practitioners. Overall adherence with CDSS recommendations for the five most common diagnoses (pharyngitis, otitis media, sinusitis, bronchitis, and upper respiratory tract infection) was 82%. When antibiotics were prescribed (53% of cases), adherence with the CDSS-recommended antibiotic was high (76%). By logistic regression analysis, the odds of adherence with CDSS recommendations increased significantly with each ten cases completed (P=0.001). Questionnaire respondents believed the CDSS was easy to use, and most (44/65; 68%) did not believe it increased their encounter time with patients, regardless of prior experience with PDAs.
Conclusion A standalone PDA-based CDSS for acute RTIs used at the point-of-care can encourage better outpatient antimicrobial prescribing practices and easily gather a rich set of clinical data.
Footnotes
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Funding was provided by the Centers for Disease Control and Prevention, grant number RS1 CCR820631. Portions of this study were presented in abstract form at the 44th Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington, D.C., October 2004. The authors of this study have no conflicts of interest to report. The PDA-based CDSS described in this study was designed by study investigators working with TheraDoc (Salt Lake City, UT) as the technology partner. The program was created only for research purposes only and is not commercially available. Readers interested in further details of this instrument are encouraged to contact the corresponding author.
