Development and implementation of a clinical decision support tool for treatment of uncomplicated urinary tract infections in a family medicine resident clinic

Sarah Eudaley, Alexandra E. Mihm, Rebecca Higdon, Julie Jeter, Shaunta' Chamberlin

Research output: Contribution to journalArticle

Abstract

Objectives: Outpatient antimicrobial stewardship has become increasingly important. While clinical decision support (CDS) tools have been effective in improving guideline-directed antibiotic prescribing, most notably for upper respiratory tract infections, their use for uncomplicated urinary tract infections (UTIs) has been less extensively studied. The objective of this study was to develop and implement a CDS tool to optimize antimicrobial prescribing for uncomplicated UTIs. Setting: University-affiliated family medicine resident clinic. Practice description: This outpatient clinic is the practice site for 24 medical residents, 12 full-time faculty physicians, 1 nurse practitioner, and 1 full-time clinical pharmacist. Practice innovation: An interdisciplinary team including physicians, pharmacists, quality coordinator, and a coding and billing specialist collaborated to develop and implement a CDS tool into the clinic electronic health record to guide diagnosis, documentation, and antibiotic prescribing for uncomplicated UTIs. Prescribing practices were characterized, and a clinic-specific antibiogram was developed to identify focus areas for the CDS tool. Evaluation: A retrospective chart review was conducted to evaluate empiric antibiotic prescribing before and after implementation of the CDS tool and after implementation when the tool was used or not used. Results: Utilization of the tool clinic-wide was 29%. Overall fluoroquinolone use decreased from 42% to 15% after tool implementation (odds ratio [OR] 0.25; 95% CI 0.13-0.5; P < 0.001). Specifically, when the CDS tool was used, no patients received empiric therapy with fluoroquinolones (P = 0.005). With use of the tool following implementation, trimethoprim/sulfamethoxazole use decreased by 20% (OR 0.21; 95% CI 0.45-0.955; P = 0.003), nitrofurantoin for cystitis increased by 31% (OR 3.83; 95% CI 1.32-11.1; P = 0.01), and guideline-directed duration of therapy increased 32% (OR 4.34; 95% CI 1.48-12.73; P = 0.005). Conclusion: In an attempt to optimize empiric antimicrobial treatment for uncomplicated UTIs, we developed and implemented a CDS tool into the electronic health record in a family medicine resident clinic. Despite a 29% usage rate, many benefits were seen after tool implementation.

Original languageEnglish (US)
JournalJournal of the American Pharmacists Association
DOIs
StatePublished - Jan 1 2019

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Clinical Decision Support Systems
Urinary Tract Infections
Medicine
Odds Ratio
Electronic Health Records
Fluoroquinolones
Anti-Bacterial Agents
Pharmacists
Therapeutics
Guidelines
Physicians
Nitrofurantoin
Cystitis
Nurse Practitioners
Sulfamethoxazole Drug Combination Trimethoprim
Microbial Sensitivity Tests
Ambulatory Care Facilities
Respiratory Tract Infections
Documentation
Health

All Science Journal Classification (ASJC) codes

  • Pharmacology (nursing)
  • Pharmacy
  • Pharmacology

Cite this

@article{42ae103be00944358a1dc1ae2495ea68,
title = "Development and implementation of a clinical decision support tool for treatment of uncomplicated urinary tract infections in a family medicine resident clinic",
abstract = "Objectives: Outpatient antimicrobial stewardship has become increasingly important. While clinical decision support (CDS) tools have been effective in improving guideline-directed antibiotic prescribing, most notably for upper respiratory tract infections, their use for uncomplicated urinary tract infections (UTIs) has been less extensively studied. The objective of this study was to develop and implement a CDS tool to optimize antimicrobial prescribing for uncomplicated UTIs. Setting: University-affiliated family medicine resident clinic. Practice description: This outpatient clinic is the practice site for 24 medical residents, 12 full-time faculty physicians, 1 nurse practitioner, and 1 full-time clinical pharmacist. Practice innovation: An interdisciplinary team including physicians, pharmacists, quality coordinator, and a coding and billing specialist collaborated to develop and implement a CDS tool into the clinic electronic health record to guide diagnosis, documentation, and antibiotic prescribing for uncomplicated UTIs. Prescribing practices were characterized, and a clinic-specific antibiogram was developed to identify focus areas for the CDS tool. Evaluation: A retrospective chart review was conducted to evaluate empiric antibiotic prescribing before and after implementation of the CDS tool and after implementation when the tool was used or not used. Results: Utilization of the tool clinic-wide was 29{\%}. Overall fluoroquinolone use decreased from 42{\%} to 15{\%} after tool implementation (odds ratio [OR] 0.25; 95{\%} CI 0.13-0.5; P < 0.001). Specifically, when the CDS tool was used, no patients received empiric therapy with fluoroquinolones (P = 0.005). With use of the tool following implementation, trimethoprim/sulfamethoxazole use decreased by 20{\%} (OR 0.21; 95{\%} CI 0.45-0.955; P = 0.003), nitrofurantoin for cystitis increased by 31{\%} (OR 3.83; 95{\%} CI 1.32-11.1; P = 0.01), and guideline-directed duration of therapy increased 32{\%} (OR 4.34; 95{\%} CI 1.48-12.73; P = 0.005). Conclusion: In an attempt to optimize empiric antimicrobial treatment for uncomplicated UTIs, we developed and implemented a CDS tool into the electronic health record in a family medicine resident clinic. Despite a 29{\%} usage rate, many benefits were seen after tool implementation.",
author = "Sarah Eudaley and Mihm, {Alexandra E.} and Rebecca Higdon and Julie Jeter and Shaunta' Chamberlin",
year = "2019",
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language = "English (US)",
journal = "Journal of the American Pharmacists Association : JAPhA",
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T1 - Development and implementation of a clinical decision support tool for treatment of uncomplicated urinary tract infections in a family medicine resident clinic

AU - Eudaley, Sarah

AU - Mihm, Alexandra E.

AU - Higdon, Rebecca

AU - Jeter, Julie

AU - Chamberlin, Shaunta'

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: Outpatient antimicrobial stewardship has become increasingly important. While clinical decision support (CDS) tools have been effective in improving guideline-directed antibiotic prescribing, most notably for upper respiratory tract infections, their use for uncomplicated urinary tract infections (UTIs) has been less extensively studied. The objective of this study was to develop and implement a CDS tool to optimize antimicrobial prescribing for uncomplicated UTIs. Setting: University-affiliated family medicine resident clinic. Practice description: This outpatient clinic is the practice site for 24 medical residents, 12 full-time faculty physicians, 1 nurse practitioner, and 1 full-time clinical pharmacist. Practice innovation: An interdisciplinary team including physicians, pharmacists, quality coordinator, and a coding and billing specialist collaborated to develop and implement a CDS tool into the clinic electronic health record to guide diagnosis, documentation, and antibiotic prescribing for uncomplicated UTIs. Prescribing practices were characterized, and a clinic-specific antibiogram was developed to identify focus areas for the CDS tool. Evaluation: A retrospective chart review was conducted to evaluate empiric antibiotic prescribing before and after implementation of the CDS tool and after implementation when the tool was used or not used. Results: Utilization of the tool clinic-wide was 29%. Overall fluoroquinolone use decreased from 42% to 15% after tool implementation (odds ratio [OR] 0.25; 95% CI 0.13-0.5; P < 0.001). Specifically, when the CDS tool was used, no patients received empiric therapy with fluoroquinolones (P = 0.005). With use of the tool following implementation, trimethoprim/sulfamethoxazole use decreased by 20% (OR 0.21; 95% CI 0.45-0.955; P = 0.003), nitrofurantoin for cystitis increased by 31% (OR 3.83; 95% CI 1.32-11.1; P = 0.01), and guideline-directed duration of therapy increased 32% (OR 4.34; 95% CI 1.48-12.73; P = 0.005). Conclusion: In an attempt to optimize empiric antimicrobial treatment for uncomplicated UTIs, we developed and implemented a CDS tool into the electronic health record in a family medicine resident clinic. Despite a 29% usage rate, many benefits were seen after tool implementation.

AB - Objectives: Outpatient antimicrobial stewardship has become increasingly important. While clinical decision support (CDS) tools have been effective in improving guideline-directed antibiotic prescribing, most notably for upper respiratory tract infections, their use for uncomplicated urinary tract infections (UTIs) has been less extensively studied. The objective of this study was to develop and implement a CDS tool to optimize antimicrobial prescribing for uncomplicated UTIs. Setting: University-affiliated family medicine resident clinic. Practice description: This outpatient clinic is the practice site for 24 medical residents, 12 full-time faculty physicians, 1 nurse practitioner, and 1 full-time clinical pharmacist. Practice innovation: An interdisciplinary team including physicians, pharmacists, quality coordinator, and a coding and billing specialist collaborated to develop and implement a CDS tool into the clinic electronic health record to guide diagnosis, documentation, and antibiotic prescribing for uncomplicated UTIs. Prescribing practices were characterized, and a clinic-specific antibiogram was developed to identify focus areas for the CDS tool. Evaluation: A retrospective chart review was conducted to evaluate empiric antibiotic prescribing before and after implementation of the CDS tool and after implementation when the tool was used or not used. Results: Utilization of the tool clinic-wide was 29%. Overall fluoroquinolone use decreased from 42% to 15% after tool implementation (odds ratio [OR] 0.25; 95% CI 0.13-0.5; P < 0.001). Specifically, when the CDS tool was used, no patients received empiric therapy with fluoroquinolones (P = 0.005). With use of the tool following implementation, trimethoprim/sulfamethoxazole use decreased by 20% (OR 0.21; 95% CI 0.45-0.955; P = 0.003), nitrofurantoin for cystitis increased by 31% (OR 3.83; 95% CI 1.32-11.1; P = 0.01), and guideline-directed duration of therapy increased 32% (OR 4.34; 95% CI 1.48-12.73; P = 0.005). Conclusion: In an attempt to optimize empiric antimicrobial treatment for uncomplicated UTIs, we developed and implemented a CDS tool into the electronic health record in a family medicine resident clinic. Despite a 29% usage rate, many benefits were seen after tool implementation.

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