Performance of the TREAT decision support system in an environment with a low prevalence of resistant pathogens

Kofoed, Kristian; Zalounina, Alina; Andersen, Ove; Lisby, Gorm; Leibovici, Leonard; Andreassen, Steen

doi:10.1093/jac/dkn504

Cited by 22 publications

(12 citation statements)

References 17 publications

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“…[18,20,24,27,29,31,33,34,36,44,50,52,55,59,62] Values for cost of antibiotic use are summarised in Table 4. The unit of cost report varied making it difficult to measure the overall impact of CDS.…”

Section: Resultsmentioning

confidence: 99%

The effectiveness of computerised decision support on antibiotic use in hospitals: A systematic review

2017

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BackgroundInappropriate antimicrobial use has been shown to be an important determinant of the emergence of antimicrobial resistance (AMR). Health information technology (HIT) in the form of Computerised Decision Support (CDS) represents an option for improving antimicrobial prescribing and containing AMR.ObjectivesTo evaluate the evidence for CDS in improving quantitative and qualitative measures of antibiotic prescribing in inpatient hospital settings.MethodsA systematic literature search was conducted of articles published from inception to 20th December 2014 using eight electronic databases: MEDLINE, EMBASE, PUBMED, Web of Science, CINAHL, Cochrane Library, HMIC and PsychINFo. An updated systematic literature search was conducted from January 1st 2015 to October 1st 2016 using PUBMED. The search strategy used combinations of the following terms: (electronic prescribing) OR (clinical decision support) AND (antibiotic or antibacterial or antimicrobial) AND (hospital or secondary care or inpatient). Studies were evaluated for quality using a 10-point rating scale.ResultsEighty-one studies were identified matching the inclusion criteria. Seven outcome measures were evaluated: adequacy of antibiotic coverage, mortality, volume of antibiotic usage, length of stay, antibiotic cost, compliance with guidelines, antimicrobial resistance, and CDS implementation and uptake. Meta-analysis of pooled outcomes showed CDS significantly improved the adequacy of antibiotic coverage (n = 13; odds ratio [OR], 2.11 [95% CI, 1.67 to 2.66, p ≤ 0.00001]). Also, CDS was associated with marginally lowered mortality (n = 20; OR, 0.85 [CI, 0.75 to 0.96, p = 0.01]). CDS was associated with lower antibiotic utilisation, increased compliance with antibiotic guidelines and reductions in antimicrobial resistance. Conflicting effects of CDS on length of stay, antibiotic costs and system uptake were also noted.ConclusionsCDS has the potential to improve the adequacy of antibiotic coverage and marginally decrease mortality in hospital-related settings.

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Section: Resultsmentioning

confidence: 99%

The effectiveness of computerised decision support on antibiotic use in hospitals: A systematic review

2017

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“…We found that most work has been conducted in relation to CPOE and CDS systems, focusing on interventions that targeted individual prescribers through prompts and reminders …”

Section: Resultsmentioning

confidence: 99%

Approaches to promoting the appropriate use of antibiotics through hospital electronic prescribing systems: a scoping review

et al. 2016

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Objective To identify approaches of using stand-alone and more integrated hospital ePrescribing systems to promote and support the appropriate use of antibiotics, and identify gaps in order to inform future efforts in this area. Methods A systematic scoping review of the empirical literature from 1997 until 2015, searching the following databases: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Google Scholar, Clinical Trials, International Standard Randomised Controlled Trial Number Registry, Economic Evaluation database and International Prospective Register of Systematic Reviews. Search terms related to different components of systems, hospital settings and antimicrobial stewardship. Two reviewers independently screened papers and mutually agreed papers for inclusion. We undertook an interpretive synthesis. Key findings We identified 143 papers. The majority of these were single-centre observational studies from North American settings with a wide range of system functionalities. Most evidence related to computerised decision support (CDS) and computerised physician order entry (CPOE) functionalities, of which many were extensively customised. We also found some limited work surrounding integration with laboratory results, pharmacy systems and organisational surveillance. Outcomes examined included healthcare professional performance, patient outcomes and health economic evaluations. We found at times conflicting conclusions surrounding effectiveness, which may be due to heterogeneity of populations, technologies and outcomes studied. Reports of unintended consequences were limited. Conclusions Interventions are centred on CPOE and CDS, but also include additional functionality aiming to support various facets of the medicines management process. Wider organisational dimensions appear important to supporting adoption. Evaluations should consider processes, clinical, economic and safety outcomes in order to generate generalisable insights into safety, effectiveness and cost-effectiveness.

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“…Features of such systems deemed critical for improving clinical practice included decision support provided automatically within the clinical workflow, given at the time and location of decision-making, and that is computer-generated [11]. Antibiotic computerised decision support systems (CDSSs) incorporating these critical features have been developed to facilitate optimal antibiotic prescribing [12][13][14][15][16]. Antibiotic CDSSs are particularly useful for antibiotic selection for empirical therapy, as optimal selection is complex when the causative pathogen is as yet unknown and it is when the greatest discordance with recommended antibiotic guidelines occurs [17,18].…”

Section: Introductionmentioning

confidence: 99%

Psychosocial determinants of physicians’ acceptance of recommendations by antibiotic computerised decision support systems: A mixed methods study

Chow

Lye

Arah

2015

International Journal of Antimicrobial Agents

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Performance of the TREAT decision support system in an environment with a low prevalence of resistant pathogens

Abstract: The results of the study suggest that TREAT can improve the appropriateness of antimicrobial therapy and reduce the cost of side effects in regions with a low prevalence of resistant pathogens, however, at the expense of increased use of antibiotics.

Cited by 22 publications

References 17 publications

The effectiveness of computerised decision support on antibiotic use in hospitals: A systematic review

The effectiveness of computerised decision support on antibiotic use in hospitals: A systematic review

Approaches to promoting the appropriate use of antibiotics through hospital electronic prescribing systems: a scoping review

Psychosocial determinants of physicians’ acceptance of recommendations by antibiotic computerised decision support systems: A mixed methods study

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