Effect of an Explicit Decision-support Tool on Decisions to Prescribe Antibiotics for Sore Throat

Studies of scoring rules for sore throat have failed to show that they lower antibiotic prescription rates. The authors studied the effect of an explicit decision-support tool, incorporating a modified score, on antibiotic-prescription decisions, Four hundred and fifty family physicians received an information package, a score card, and a recording form to use during one sore-throat encounter. The physicians randomly received either a control form or an intervention form that required them to interact with the score during the clinical recording process. There was a trend towards a reduction in anti-biotic prescriptions (21%, p = 0.09) in the physicians using the intervention form. A greater reduction (45%, p = 0.06) was observed for patients whose probabilities of infection with group A streptococcus were low. Sore-throat-scoring rules may reduce unnecessary antibiotic prescriptions if physicians are specifically cued to use them during clinical encounters and appropriate management responses are linked to score estimates for the likelihood of group A streptococcus infection. Key words: pharyngitis; clinical score; antibiotic prescribing; reminders. (MedDecisMaking1998;18:220-228) Heuristics, the general rules of thumb about diag