Electronic Health Records for Intervention Research: A Cluster Randomized Trial to Reduce Antibiotic Prescribing in Primary Care (eCRT Study)

In Brief

Electronic Health Records for Intervention Research: A Cluster Randomized Trial to Reduce Antibiotic Prescribing in Primary Care (eCRT Study)

Alex Dregan , and colleagues

Background Because implementing cluster randomized trials can be logistically challenging, costly and time-consuming, researchers sought to evaluate the feasibility of conducting intervention research remotely using primary care electronic health records. Specifically, the authors looked at the effectiveness of electronically delivered decision support tools at reducing antibiotic prescribing for respiratory tract infections in a randomized trial of 603,409 primary care patients in England and Scotland.

What This Study Found Intervention arm practices used decision support tools remotely installed and delivered during consultations that were activated when family physicians entered a medical code for the respiratory tract infection. The tools provided information for education and decision support, including a summary of antibiotic prescribing recommendations, a patient-information sheet, summary of research evidence concerning no-antibiotic or delayed-antibiotic prescribing strategies, information on the definite indications for antibiotic prescription and information and evidence on the risks from nonprescribing. The researchers found the use of the intervention and its effect on care were low ? one-quarter of intervention family practices made little or no use of the intervention, and antibiotic prescribing was only slightly lower at practices that made greater use of the intervention (a 1.85% reduction in the proportion of consultations with antibiotics prescribed). Despite the limited impact, however, the study demonstrates that cluster randomized trials can be conducted remotely through electronic health records.

Implications

• Using electronic health records in intervention research, the authors assert, has the potential to allow large studies to be conducted at a low cost in settings where care is routinely delivered, making it suitable for the evaluation of important clinical and public health interventions.