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Jewish World Review Feb. 8, 2001 / 15 Shevat, 5761

Lee Bowman

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Consumer Reports


Online info affects the way doctors prescribe, study finds

http://www.jewishworldreview.com -- An on-screen, pop-up reminder to pediatricians prescribing via computer cut the likelihood of excessive dosing of antibiotics by one-third, researchers report.

The new technique is part of an information revolution sweeping medicine as health professionals turn to keyboards and palmtops to diagnose, chart and prescribe.

Dr. Dimitri Christakis and his colleagues at the University of Washington School of Medicine have been looking for effective ways to get up-to-date medical research into the hands of practicing doctors as they make decisions about care. In particular, they're trying to effectively boil down the information overload that besets many doctors.

"The information in this program does not overwhelm the physician,'' said Christakis, an assistant professor of pediatrics and lead author of the study, which appears in the February issue of the journal Pediatrics. "What it does do is take the latest research and then get it into practice.''

Traditionally, doctors read medical journals or attend seminars and conferences to keep up with the latest in their fields. But there are an estimated 20,000 medical journals offering updates on various specialties and an ever-growing calendar of medical meetings.

Other researchers have found that efforts to apply the latest medical knowledge to practice in person, in print or even on Web sites often don't work because they require doctors to change their examination-room procedures.

But at the University of Washington's Pediatric Care Center in Seattle, 38 doctors and nurse practitioners were already using a networked system of computer workstations to track some patient information and write prescriptions.

Christakis and his team then programmed the system so that some of the prescribing physicians were greeted with pop-up screens based on their selection of antibiotics and duration of the prescription.

Each screen gave a short summary of the latest evidence, particularly a 1998 study from the Journal of the American Medical Association that said a five-day course of treatment with antibiotics for an ear infection was as effective as the more common 10-day dosing. Shorter treatment with the drugs is also thought to help reduce the chance that bacteria will develop resistance to antibiotics. The doctors were given several options to click and see more detailed evidence to back up the advice.

For the next eight months, the researchers tracked how doctors who got the messages prescribed for ear infections compared with those who didn't get the advice. Since the study took place mainly in the fall and winter, all the doctors wrote more prescriptions for ear infections than they had in the previous six months.

But the doctors getting the messages were 34 percent less likely to prescribe antibiotics for 10 days or longer than the control group, although longer prescriptions did fall by 10 percent in that group, too.

The researchers believe the control group was influenced by discussions with colleagues who were getting the messages, "but nonetheless, the intervention group experienced significantly greater behavior change,'' Christakis said.

Currently, only 1 or 2 percent of the more than 3 billion prescriptions written in the United States each year are being run through computers. And most of the information those programs provide to doctors concerns whether a drug is covered by an insurer or is safe for a patient, rather than what dose is appropriate.

Christakis said more electronic medical advice is likely to be provided to physicians as e-prescription numbers continue to grow over the next decade, however.

On the Net: http://www.pediatrics.org

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