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Use of a Personal Digital Assistant for Managing Antibiotic Prescribing for Outpatient Respiratory Tract Infections in Rural Communities

^a Department of Medical Informatics, University of Utah, Salt Lake City, UT
^b Department of Internal Medicine, University of Utah, Salt Lake City, UT
^c HealthInsight, Salt Lake City, UT
^d Qualis Health, Boise, ID (now at Department of Internal Medicine, Ohio State University College of Medicine, Columbus, OH)

^_* Correspondence and reprints: Michael A. Rubin, MD PhD, Department of Internal Medicine and, Department of Medical Informatics, University of Utah School of Medicine, 300 North 1900 East, Room AC-230A, Salt Lake City, UT 84132. (Email: Michael.Rubin{at}hsc.utah.edu).

Received for publication: 12/01/05; accepted for publication: 08/01/06.

OBJECTIVE: To assess the acceptability and usage of a standalone personal digital assistant (PDA)-based clinical decision-support system (CDSS) for the diagnosis and management of acute respiratory tract infections (RTIs) in the outpatient setting.

DESIGN: Observational study performed as part of a larger randomized trial in six rural communities in Utah and Idaho from January 2002 to March 2004. Ninety-nine primary care providers received a PDA-based CDSS for use at the point-of-care, and were asked to use the tool with at least 200 patients with suspected RTIs.

MEASUREMENTS: Clinical data were collected electronically from the devices at periodic intervals. Providers also completed an exit questionnaire at the end of the study period.

RESULTS: Providers logged 14,393 cases using the CDSS, the majority of which (n=7624; 53%) were from family practitioners. Overall adherence with CDSS recommendations for the five most common diagnoses (pharyngitis, otitis media, sinusitis, bronchitis, and upper respiratory tract infection) was 82%. When antibiotics were prescribed (53% of cases), adherence with the CDSS-recommended antibiotic was high (76%). By logistic regression analysis, the odds of adherence with CDSS recommendations increased significantly with each ten cases completed (P=0.001). Questionnaire respondents believed the CDSS was easy to use, and most (44/65; 68%) did not believe it increased their encounter time with patients, regardless of prior experience with PDAs.

CONCLUSION: A standalone PDA-based CDSS for acute RTIs used at the point-of-care can encourage better outpatient antimicrobial prescribing practices and easily gather a rich set of clinical data.