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Electronic health records for intervention research: a cluster randomized trial to reduce antibiotic prescribing in primary care (eCRT Study)

Electronic health records for intervention research: a cluster randomized trial to reduce antibiotic prescribing in primary care (eCRT Study)
Electronic health records for intervention research: a cluster randomized trial to reduce antibiotic prescribing in primary care (eCRT Study)
PURPOSE This study aimed to implement a point-of-care cluster randomized trial using electronic health records. We evaluated the effectiveness of electronically delivered decision support tools at reducing antibiotic prescribing for respiratory tract infections in primary care.

METHODS Family practices from England and Scotland participating in the Clinical Practice Research Datalink (CPRD) were included in the trial; 53 family practices were allocated to intervention and 51 practices were allocated to usual care. Patients aged 18 to 59 years consulting for respiratory tract infections were eligible. The intervention was through remotely installed, computer-delivered decision support tools accessed during the consultations. Control practices provided usual care. The primary outcome was the proportion of consultations for respiratory tract infections with an antibiotic prescribed based on electronic health records. Family practice-specific proportions were included in a cluster-level analysis.

RESULTS Data were analyzed for 603,409 patients: 317,717 at intervention practices and 285,692 at control practices. Use of the intervention was less than anticipated, varying among practices. There was a reduction in proportion of consultations with antibiotics prescribed of 1.85% (95% CI, 0.10%–3.59%, P = .038) and in the rate of antibiotic prescribing for respiratory tract infections (9.69%; 95% CI, 0.75%–18.63%, fewer prescriptions per 1,000 patient-years, P = .034). There were no adverse events.

CONCLUSIONS Cluster randomized trials may be implemented efficiently in large samples from routine care settings by using primary care electronic health records. Future studies should develop and test multicomponent methods for remotely delivered intervention.
1544-1709
344-351
Gulliford, Martin C.
5c557aa2-db12-43a2-8778-eac74cf42138
van Staa, Tjeerd
062ecdf4-b73c-47b3-ba9e-48aa0a47e519
Dregan, Alex
3e9f701f-54d9-4519-a7b7-e18e05b427c7
McDermott, Lisa
10aa4fe3-7260-4080-8f8b-7c14b3ca409e
McCann, Gerard
d970a747-db34-4088-9fc5-63befb3479d3
Ashworth, Mark
51302b16-d1e8-4221-a192-04aebdd16f77
Charlton, Judith
27682a6d-c126-45fb-a8a1-dbde57ccb4e9
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Moore, Michael V.
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Gulliford, Martin C.
5c557aa2-db12-43a2-8778-eac74cf42138
van Staa, Tjeerd
062ecdf4-b73c-47b3-ba9e-48aa0a47e519
Dregan, Alex
3e9f701f-54d9-4519-a7b7-e18e05b427c7
McDermott, Lisa
10aa4fe3-7260-4080-8f8b-7c14b3ca409e
McCann, Gerard
d970a747-db34-4088-9fc5-63befb3479d3
Ashworth, Mark
51302b16-d1e8-4221-a192-04aebdd16f77
Charlton, Judith
27682a6d-c126-45fb-a8a1-dbde57ccb4e9
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Moore, Michael V.
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e

Gulliford, Martin C., van Staa, Tjeerd, Dregan, Alex, McDermott, Lisa, McCann, Gerard, Ashworth, Mark, Charlton, Judith, Little, Paul, Moore, Michael V. and Yardley, Lucy (2014) Electronic health records for intervention research: a cluster randomized trial to reduce antibiotic prescribing in primary care (eCRT Study). Annals of Family Medicine, 12 (4), 344-351. (doi:10.1370/afm.1659). (PMID:25024243)

Record type: Article

Abstract

PURPOSE This study aimed to implement a point-of-care cluster randomized trial using electronic health records. We evaluated the effectiveness of electronically delivered decision support tools at reducing antibiotic prescribing for respiratory tract infections in primary care.

METHODS Family practices from England and Scotland participating in the Clinical Practice Research Datalink (CPRD) were included in the trial; 53 family practices were allocated to intervention and 51 practices were allocated to usual care. Patients aged 18 to 59 years consulting for respiratory tract infections were eligible. The intervention was through remotely installed, computer-delivered decision support tools accessed during the consultations. Control practices provided usual care. The primary outcome was the proportion of consultations for respiratory tract infections with an antibiotic prescribed based on electronic health records. Family practice-specific proportions were included in a cluster-level analysis.

RESULTS Data were analyzed for 603,409 patients: 317,717 at intervention practices and 285,692 at control practices. Use of the intervention was less than anticipated, varying among practices. There was a reduction in proportion of consultations with antibiotics prescribed of 1.85% (95% CI, 0.10%–3.59%, P = .038) and in the rate of antibiotic prescribing for respiratory tract infections (9.69%; 95% CI, 0.75%–18.63%, fewer prescriptions per 1,000 patient-years, P = .034). There were no adverse events.

CONCLUSIONS Cluster randomized trials may be implemented efficiently in large samples from routine care settings by using primary care electronic health records. Future studies should develop and test multicomponent methods for remotely delivered intervention.

Full text not available from this repository.

More information

Published date: July 2014
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 367234
URI: https://eprints.soton.ac.uk/id/eprint/367234
ISSN: 1544-1709
PURE UUID: 1ba3cab7-3e4a-4765-8a9b-28cf82d566d6
ORCID for Michael V. Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X

Catalogue record

Date deposited: 25 Jul 2014 13:13
Last modified: 14 Oct 2019 18:59

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