First author and year of publication (citation number) | Study design | Intervention description (Medication type/group targeted in italics) | Outcome measures, including direction of effect | ||||||
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.