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首页> 美国卫生研究院文献>Journal of the American Medical Informatics Association : JAMIA >Effects of computer-aided clinical decision support systems in improving antibiotic prescribing by primary care providers: a systematic review
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Effects of computer-aided clinical decision support systems in improving antibiotic prescribing by primary care providers: a systematic review

机译：计算机辅助临床决策支持系统在改善初级保健提供者抗生素处方中的作用：系统评价

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>Objective To assess the effectiveness of computer-aided clinical decision support systems (CDSS) in improving antibiotic prescribing in primary care.>Methods A literature search utilizing Medline (via PubMed) and Embase (via Embase) was conducted up to November 2013. Randomized controlled trials (RCTs) and cluster randomized trials (CRTs) that evaluated the effects of CDSS aiming at improving antibiotic prescribing practice in an ambulatory primary care setting were included for review. Two investigators independently extracted data about study design and quality, participant characteristics, interventions, and outcomes.>Results Seven studies (4 CRTs, 3 RCTs) met our inclusion criteria. All studies were performed in the USA. Proportions of eligible patient visits that triggered CDSS use varied substantially between intervention arms of studies (range 2.8–62.8%). Five out of seven trials showed marginal to moderate statistically significant effects of CDSS in improving antibiotic prescribing behavior. CDSS that automatically provided decision support were more likely to improve prescribing practice in contrast to systems that had to be actively initiated by healthcare providers.>Conclusions CDSS show promising effectiveness in improving antibiotic prescribing behavior in primary care. Magnitude of effects compared to no intervention, appeared to be similar to other moderately effective single interventions directed at primary care providers. Additional research is warranted to determine CDSS characteristics crucial to triggering high adoption by providers as a perquisite of clinically relevant improvement of antibiotic prescribing.
机译：>目的以评估计算机辅助临床决策支持系统（CDSS）在改善初级保健中抗生素处方的有效性。>方法利用Medline（通过PubMed）和Embase进行文献检索（通过Embase进行）至2013年11月。评估了CDSS旨在改善非卧床初级保健环境中抗生素处方实践效果的随机对照试验（RCT）和整群随机试验（CRT）进行审查。两名研究人员独立地提取了有关研究设计和质量，参与者特征，干预措施和结果的数据。>结果七项研究（4项CRT，3项RCT）符合我们的纳入标准。所有研究均在美国进行。在干预研究之间，触发使用CDSS的合格患者就诊比例差异很大（范围为2.8–62.8％）。七项试验中有五项显示CDSS在改善抗生素处方行为方面在统计学上具有边际至中度的显着影响。与必须由医疗服务提供者主动启动的系统相比，自动提供决策支持的CDSS更有可能改善处方实践。>结论 CDSS在改善初级保健中的抗生素处方行为方面显示出可观的效果。与没有干预措施相比，影响的幅度似乎与针对初级保健提供者的其他中等有效的单一干预措施相似。有必要进行额外的研究来确定CDSS特征，这些特征对于触发提供者的广泛采用至关重要，因为这是对抗生素处方的临床相关改进的要求。

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