To the Editor: Dr Samore and colleagues1 described the results of an effort to improve appropriateness of antibiotic use with a clinical decision support system (CDSS). We have some concerns whether the difference in effect between the CDSS group and the community intervention group can be ascribed to the decision support that was offered.
Table 2 indicates that several components of the community intervention differed between the 2 groups, favoring the CDSS group. Although the groups were roughly similar in population size, 83% more posters and 42% more brochures were distributed in the communities in the CDSS group. Household mailings and self-care guides distributed at health fairs also favored the CDSS group by 23% and 26%, respectively. The difference in intensity of the community intervention is an alternate explanation for the difference in effect between the 2 groups.
van der Wouden JC, Kuyvenhoven MM. Clinical Decision Support Systems and Antibiotic Prescribing. JAMA. 2006;295(15):1771. doi:10.1001/jama.295.15.1771-a
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