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April 19, 2006

Clinical Decision Support Systems and Antibiotic Prescribing—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;295(15):1771. doi:10.1001/jama.295.15.1771-b

In Reply: Drs van der Wouden and Kuyvenhoven offer the alternative hypothesis that the effects on antimicrobial prescribing that were observed in our study were secondary to differences in implementation of the community intervention rather than a consequence of clinical decision support system (CDSS) use. We believe that this explanation is not supported by the study results. Communities randomized to the community intervention alone arm did not demonstrate any change in total antimicrobial drug use or drug selection during the intervention compared with baseline. The marked decrease in macrolide prescriptions within CDSS communities, in line with the recommendations of the CDSS tools, is also much more compatible with a physician-based effect.