Trial reportJournal of general internal medicine2020
Impact of Clinical Decision Support on Antibiotic Prescribing for Acute Respiratory Infections: a Cluster Randomized Implementation Trial.
Trial report in Journal of general internal medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02534987 (Integrated Clinical Prediction Rules), which is not on this map. Cited by 19 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Integrated Clinical Prediction Rules: Bringing Evidence to Diverse Primary Care Settings
Who cites it
19 citing papers in PubMed, 4 syntheses or guidelines pooled it, 30 citations in OpenAlex.
- Implementation, adoption and impact of clinical decision support system for antibiotic prescribing in primary care: a systematic review.The Journal of antimicrobial chemotherapy · 2026Pooled it
- Characterizing Behaviors That Influence the Implementation of Digital-Based Interventions in Health Care: Systematic Review.Journal of medical Internet research · 2025Pooled it
- Effectiveness of decision support tools on reducing antibiotic use for respiratory tract infections: a systematic review and meta-analysis.Frontiers in pharmacology · 2023Pooled it
- Biomarkers as point-of-care tests to guide prescription of antibiotics in people with acute respiratory infections in primary care.The Cochrane database of systematic reviews · 2022Pooled it
- Effectiveness of a clinical decision support algorithm (CDSA) on reducing unnecessary antibiotic prescriptions for upper respiratory tract infections among ambulatory HIV-infected adults in Mozambique: a cluster randomized controlled trial.BMC infectious diseases · 2026Trial
- Effects of a comprehensive antibiotic stewardship program on antibiotic prescribing for acute respiratory infections in rural facilities: a cluster randomized trial.Nature medicine · 2026Trial
- Effects of a Guideline-Informed Clinical Decision Support System Intervention to Improve Colony-Stimulating Factor Prescribing: A Cluster Randomized Clinical Trial.JAMA network open · 2022Trial
- Physicians' preferences for the use of clinical decision support systems in the context of acutely ill children presenting to ambulatory care: a focus group study.BMC medical informatics and decision making · 2026Article
- Review
- Barriers and Enablers for Sustaining Nurse-Led Use of Clinical Decision Support Tools for Antibiotic Stewardship: Qualitative Study.JMIR nursing · 2026Article
- Article
- The role of electronic health records systems in de-implementing low-value care in primary care: a scoping review.Implementation science communications · 2025Review
- Article
- Barriers to Implementing Registered Nurse-Driven Clinical Decision Support for Antibiotic Stewardship: Retrospective Case Study.JMIR formative research · 2024Article
- Ambulatory antibiotic prescription rates for acute respiratory infection rebound two years after the start of the COVID-19 pandemic.PloS one · 2024Article
- Reducing prescribing of antibiotics for acute respiratory infections using a frontline nurse-led EHR-Integrated clinical decision support tool: protocol for a stepped wedge randomized control trial.BMC medical informatics and decision making · 2023Article
- Factors driving provider adoption of the TREWS machine learning-based early warning system and its effects on sepsis treatment timing.Nature medicine · 2022Article
- Assessing Reduction of Antibiotic Prescribing for Acute, Non-Complicated Infections in Primary Care in Germany: Multi-Step Outcome Evaluation in the Cluster-Randomized Trial ARena.Antibiotics (Basel, Switzerland) · 2021Article
- Responding to the Call: a New JGIM Area of Emphasis for Implementation and Quality Improvement Sciences.Journal of general internal medicine · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundClinical decision support (CDS) is a promising tool for reducing antibiotic prescribing for acute respiratory infections (ARIs).
objectiveTo assess the impact of previously effective CDS on antibiotic-prescribing rates for ARIs when adapted and implemented in diverse primary care settings.
designCluster randomized clinical trial (RCT) implementing a CDS tool designed to guide evidence-based evaluation and treatment of streptococcal pharyngitis and pneumonia.
settingTwo large academic health system primary care networks with a mix of providers.
participantsAll primary care practices within each health system were invited. All providers within participating clinic were considered a participant. Practices were randomized selection to a control or intervention group.
interventionsIntervention practice providers had access to an integrated clinical prediction rule (iCPR) system designed to determine the risk of bacterial infection from reason for visit of sore throat, cough, or upper respiratory infection and guide evidence-based evaluation and treatment. MAIN OUTCOME(S): Change in overall antibiotic prescription rates. MEASURE(S): Frequency, rates, and type of antibiotics prescribed in intervention and controls groups.
results33 primary care practices participated with 541 providers and 100,573 patient visits. Intervention providers completed the tool in 6.9% of eligible visits. Antibiotics were prescribed in 35% and 36% of intervention and control visits, respectively, showing no statistically significant difference. There were also no differences in rates of orders for rapid streptococcal tests (RR, 0.94; P = 0.11) or chest X-rays (RR, 1.01; P = 0.999) between groups.
conclusionsThe iCPR tool was not effective in reducing antibiotic prescription rates for upper respiratory infections in diverse primary care settings. This has implications for the generalizability of CDS tools as they are adapted to heterogeneous clinical contexts.
trial registrationClinicaltrials.gov (NCT02534987). Registered August 26, 2015 at https://clinicaltrials.gov.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.