Implementation, adoption and impact of clinical decision support system for antibiotic prescribing in primary care: a systematic review.

TL;DR

A systematic review of 40 studies found that clinical decision support systems (CDSS) for antibiotic prescribing in primary care show promise for reducing overall antibiotic prescribing, but real-world adoption is highly variable and implementation faces significant barriers including alert fatigue and workflow disruption.

Key findings

• Only 5 of 11 studies reporting CDSS use showed adoption in more than half of consultations, indicating inconsistent real-world implementation despite integration into electronic health records in 60% of studies
• 17 of 32 studies assessing clinical outcomes reported reduced overall antibiotic prescribing, suggesting potential effectiveness when properly implemented
• Major barriers to CDSS adoption include alert fatigue, perceived time consumption, technical issues, and clinician concerns about impact on patient-doctor trust
• Most studies used multimodal implementation strategies combining health record modification and audit-feedback, yet variability in outcomes persists across settings

Why this matters at the bedside

CDSS for antibiotic prescribing represents a potentially valuable tool for improving guideline-concordant practice in primary care, but clinicians should be aware that real-world effectiveness depends heavily on implementation quality, workflow integration, and addressing specific barriers that limit adoption in routine clinical practice.