A Cluster Randomized Clinical Trial to Improve Prescribing Patterns in Ambulatory Pediatrics

Objectives: Having shown previously that an electronic prescription writer and decision support system improved pediatric prescribing behavior for otitis media in an academic clinic setting, we assessed whether point-of-care delivery of evidence could demonstrate similar effects for a wide range of other common pediatric conditions. Design: Cluster randomized controlled trial. Setting: A teaching clinic/clinical practice site and a primary care pediatric clinic serving a rural and semi-urban patient mix. Participants: A total of 36 providers at the teaching clinic/practice site and eight providers at the private primary pediatric clinic. Intervention: An evidence-based message system that presented real-time evidence to providers based on prescribing practices for acute otitis media, allergic rhinitis, sinusitis, constipation, pharyngitis, croup, urticaria, and bronchiolitis. Outcome measures: The proportion of prescriptions dispensed in accordance with evidence. Results: The proportion of prescriptions dispensed in accordance with evidence improved four percentage points, from 38% at baseline to 42% following the intervention. The control group improved by one percentage point, from 39% at baseline to 40% at trial's conclusion. The adjusted difference between the intervention and control groups was 8% (95% confidence interval 1%, 15%). Intervention effectiveness did not decrease with time. Conclusion: For common pediatric outpatient conditions, a point-of-care evidence-based prescription writer and decision support system was associated with significant improvements in prescribing practices.