Table 1

Summary of studies (with effect direction for those studies with effectiveness data)

First author and year of publication (citation number)	Study design	Intervention description (Medication type/group targeted in italics)	Outcome measures, including direction of effect
First author and year of publication (citation number)	Study design		Appropriateness of medication	Accuracy of indication documentation	Rates of medication usage	Error rates	Workflow-related outcomes	Other clinical outcomes	Participant perspectives
Quantitative randomised controlled trials
Meeker, 201640	Cluster RCT	Three separate behavioural interventions to reduce unnecessary antibiotic use (the first two are eP based)—suggested alternatives, accountable justification and peer comparison. Antimicrobials	Improved
Garabedian, 201920	RCT	Indication-based prescribing prototype with patient-specific list of drug choices. Specific list of medications				Improved	Improved
Quantitative non-randomised studies
Herzig, 201539	Interrupted time series	Indication selection for acid-suppressive medication that triggered an alert and guidance to the prescriber to select appropriate indication or to cancel order. Acid suppressive medications	Improved		No change
Vercheval, 201631	Interrupted time series	Policy—mandatory inclusion of indication to start or continue antibiotics and duration or review date (along with bundle of other interventions). Antimicrobials			No change			Mixed results
Richards, 200335	UBA	Web-based antimicrobial approval system, requiring prescriber to select antimicrobial and indication, which then provides the prescriber with an approval number. Antimicrobials	Improved		Improved
Lee, 200844	UBA	Structured insulin order sets, initially on paper then onto eP system. Mandatory for anything but one-time insulin order. Insulin						Improved
Warholak, 201443	UBA	Prescribers asked to provide patient’s diagnosis or indication for use as free text in the notes sections of the e-prescription. All medications					Improved
Metcalfe, 201730	UBA	Approval on antimicrobials via a mandatory indication field. Antimicrobials						Improved
Nomura, 201842	UBA	Incorporation of a provider-selected order indication field with a list of selectable indications for commonly prescribed antimicrobials. Free-text indication documentation could also be used. Antimicrobials	Mixed results
Goss, 202018	UBA	Indication-based prescribing, selection of an antibiotic based on the diagnosis entered, which is then provided as a pre-populated order form. Antimicrobials	Improved
Scardina, 202033	UBA	Addition of indication options (or free-text indication) for ceftriaxone and vancomycin orders. Antimicrobials		*			Mixed results
May, 202145	UBA	Azithromycin order panel with guidance and alternative suggestions. One antimicrobial medication	Improved					No change
Timmons, 201838	Cross-sectional analytical study	The use of drug-specific lists of appropriate indications using institutional guidelines and asked providers to choose an indication at the time of ordering. Or to select ‘other’. Antimicrobials	Improved	Decreased
Stultz, 201947	Cross-sectional analytical study	Use of order sentences for providing meningitis dosing support. Antimicrobials				Improved
Mixed methods studies
Baysari, 201711	CBA and qual interviews	Pre-written orders incorporating authorised indications. Antimicrobials	No significant change	No significant change					√
Ho, 202046	UBA and quant participant survey	Implementation of a clinical indication library into the prescribing process. Specific list of medications						*	√
Shemilt, 201932	Quant descriptive and qual survey, focus groups and interviews	Inclusion of indication at time of prescribing for antibiotic therapy and ‘when required’ medications. Antimicrobials and as required medications		*					√
Beardsley, 202036	Quant descriptive and qual survey	Indication required for antibiotics in three-step process: 1) whether prophylaxis, empirical therapy and definitive therapy; 2) which organ system; 3) which infection. Antimicrobials		*					√
Qualitative studies
Garada, 201737	Qual interviews	Documenting indication on prescriptions and dispensed medicines labels. All medication groups							√
Baysari, 201934	Qual interviews	Mandatory indication on eP systems. All medication groups							√
Quantitative descriptive studies
Gong, 201641	Quant descriptive, participant survey	Behaviour interventions to reduce unnecessary antibiotic use—suggested alternatives, accountable justification (peer comparison and pay-for-performance incentives). Antimicrobials							√

√—Participant perceptions.
*Quantitative descriptive data only (no effectiveness data).
CBA, controlled before-and-after study; eP, electronic prescribing; qual, qualitative; quant, quantitative; RCT, randomised controlled trial; UBA, uncontrolled before-and-after study.