PT  - JOURNAL ARTICLE
AU  - Martin C. Gulliford
AU  - Tjeerd van Staa
AU  - Alex Dregan
AU  - Lisa McDermott
AU  - Gerard McCann
AU  - Mark Ashworth
AU  - Judith Charlton
AU  - Paul Little
AU  - Michael V. Moore
AU  - Lucy Yardley
TI  - Electronic Health Records for Intervention Research: A Cluster Randomized Trial to Reduce Antibiotic Prescribing in Primary Care (eCRT Study)
AID  - 10.1370/afm.1659
DP  - 2014 Jul 01
TA  - The Annals of Family Medicine
PG  - 344--351
VI  - 12
IP  - 4
4099  - http://www.annfammed.org/content/12/4/344.short
4100  - http://www.annfammed.org/content/12/4/344.full
SO  - Ann Fam Med2014 Jul 01; 12
AB  - PURPOSE This study aimed to implement a point-of-care cluster randomized trial using electronic health records. We evaluated the effectiveness of electronically delivered decision support tools at reducing antibiotic prescribing for respiratory tract infections in primary care. METHODS Family practices from England and Scotland participating in the Clinical Practice Research Datalink (CPRD) were included in the trial; 53 family practices were allocated to intervention and 51 practices were allocated to usual care. Patients aged 18 to 59 years consulting for respiratory tract infections were eligible. The intervention was through remotely installed, computer-delivered decision support tools accessed during the consultations. Control practices provided usual care. The primary outcome was the proportion of consultations for respiratory tract infections with an antibiotic prescribed based on electronic health records. Family practice-specific proportions were included in a cluster-level analysis. RESULTS Data were analyzed for 603,409 patients: 317,717 at intervention practices and 285,692 at control practices. Use of the intervention was less than anticipated, varying among practices. There was a reduction in proportion of consultations with antibiotics prescribed of 1.85% (95% CI, 0.10%–3.59%, P = .038) and in the rate of antibiotic prescribing for respiratory tract infections (9.69%; 95% CI, 0.75%–18.63%, fewer prescriptions per 1,000 patient-years, P = .034). There were no adverse events. CONCLUSIONS Cluster randomized trials may be implemented efficiently in large samples from routine care settings by using primary care electronic health records. Future studies should develop and test multicomponent methods for remotely delivered intervention.