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. 2007 May 18;2(5):e25.
doi: 10.1371/journal.pctr.0020025.

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

Robert L Davis  1 , Jeffrey Wright, Francie Chalmers, Linda Levenson, Julie C Brown, Paula Lozano, Dimitri A Christakis
Affiliations

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

Robert L Davis et al. PLoS Clin Trials. .

Abstract

Objectives: Having shown previously that an electronic prescription writer and decision support system improved pediatric prescribing behavior for otitis media in an academic clinic setting, we assessed whether point-of-care delivery of evidence could demonstrate similar effects for a wide range of other common pediatric conditions.

Design: Cluster randomized controlled trial.

Setting: A teaching clinic/clinical practice site and a primary care pediatric clinic serving a rural and semi-urban patient mix.

Participants: A total of 36 providers at the teaching clinic/practice site and eight providers at the private primary pediatric clinic.

Intervention: An evidence-based message system that presented real-time evidence to providers based on prescribing practices for acute otitis media, allergic rhinitis, sinusitis, constipation, pharyngitis, croup, urticaria, and bronchiolitis.

Outcome measures: The proportion of prescriptions dispensed in accordance with evidence.

Results: The proportion of prescriptions dispensed in accordance with evidence improved four percentage points, from 38% at baseline to 42% following the intervention. The control group improved by one percentage point, from 39% at baseline to 40% at trial's conclusion. The adjusted difference between the intervention and control groups was 8% (95% confidence interval 1%, 15%). Intervention effectiveness did not decrease with time.

Conclusion: For common pediatric outpatient conditions, a point-of-care evidence-based prescription writer and decision support system was associated with significant improvements in prescribing practices.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Recruitment, Randomization, and Analysis of Providers in Study
See this image and copyright information in PMC

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