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Pharmacy World & Science

, Volume 29, Issue 4, pp 342–349 | Cite as

Clinical decision support systems and antibiotic use

  • Nada Atef SheblEmail author
  • Bryony Dean Franklin
  • Nick Barber
Review Paper

Abstract

Aim

To review and appraise randomised controlled trials (RCT) and ‘before and after' studies published on clinical decision support systems (CDSS) used to support the use of antibiotics.

Methods

A literature search was carried out in October 2006 using MEDLINE including Medical Subject Heading (MeSH) terms (1966–2006), EMBASE (Excerpta Medica, 1980–2006) and International Pharmaceutical Abstracts (IPA, 1970–2006) using the combinations of the following terms: (Decision support systems) or (CDSS) AND (antibiotics) or (anti-infectives) or (antibacterials) or (antimicrobials). Only English language papers were selected. Editorials, letters and case reports/series were excluded. The reference sections of all retrieved articles were also searched for any further relevant articles.

Results

Forty articles were identified. Five RCT and six ‘before and after' studies were retrieved. In the RCTs, three studies used computer-based CDSS, one paper-based CDSS and one a combination of both. Two studies were conducted in primary care and three within secondary care. The primary outcomes for each study were different and only three studies were significant in the favour of the use of CDSS. ‘Before and after' studies were used where RCT were not feasible. One ‘before and after' study was excluded because it did not include any control group. The remaining five included historical control groups and evaluated the use of computer-based CDSS within secondary care. Their primary outcomes also varied but all concluded significant benefits of CDSS. Only three of ten studies were conducted outside the USA; one in Switzerland and two in Australia.

Conclusion

CDSS could be a powerful tool to improve clinical care and patient outcomes. It presents a promising future for optimising antibiotic use. However, it is difficult to generalise as most studies were conducted in the United States. Although RCT are the ‘gold standard' in research, they may not be feasible to conduct. Realising that different study designs answer different questions would allow researchers to choose the most appropriate study design to evaluate CDSS in a specified setting.

Keywords

Antibacterials Antibiotics Anti-infectives Antimicrobials Clinical decision support Decision support system 

Notes

Acknowledgment

Nada Shebl is partly funded by the UK Overseas Research Award Scheme.

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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Nada Atef Shebl
    • 1
    Email author
  • Bryony Dean Franklin
    • 2
  • Nick Barber
    • 1
  1. 1.Department of Practice and Policy, The School of PharmacyUniversity of LondonLondonUK
  2. 2.Center for Medication Safety and Service Quality, Hammersmith Hospitals NHS Trust and The School of PharmacyUniversity of LondonLondonUK

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