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Behavioral intervention reduces inappropriate antibiotic prescribing

When prescribed correctly, antibiotics can be very effective in treating a variety of bacterial infections. However, U.S. clinicians often prescribe antibiotics to patients with non-bacterial infections, particularly those with acute viral respiratory tract infections, a practice that has important repercussions. Not only are antibiotics ineffective against non-bacterial infections, they may also be associated with unpleasant side effects or allergic reactions. And, over-prescription is a significant cause of population-level antibiotic resistance.

In an NIA-funded randomized clinical trial involving 248 primary care clinicians, Dr. Jason N. Doctor, of the University of Southern California, and his colleagues compared the effectiveness of three different behavioral interventions in an attempt to affect prescribing practices:

  • The accountable justifications intervention prompted clinicians to write justifications for antibiotic prescriptions in the patient’s electronic health record (EHR), following a notification that antibiotics may not be right for the patient. This was associated with an 18.1 percent decrease in inappropriate prescriptions.
  • The peer comparison intervention ranked physicians on the number of inappropriate antibiotic prescriptions they wrote. Those with the highest inappropriate prescribing rates received e-mail messages informing them that they were not “top performers” compared to others in their region who wrote fewer inappropriate prescriptions. The e-mail included the number and proportion of inappropriate antibiotic prescriptions they had written compared to the top performers. This tactic reduced inappropriate antibiotic prescriptions by 16.3 percent.
  • The suggested alternative intervention presented a pop-up message on the EHR indicating that antibiotics may not be right for the patient and suggesting a more appropriate alternative. This was associated with a 5 percent decrease in inappropriate prescriptions.

Over the 18-month intervention period, the overall number of inappropriate antibiotic prescriptions decreased by 11 percent from baseline. The researchers note that while the study sample was relatively small and depended on the use of EHRs, the use of accountable justification and peer comparison behavioral interventions resulted in meaningfully lower inappropriate prescribing rates and might be useful tools to improve the quality of care by individual clinicians.

Reference: “Effect of Behavioral Interventions on Inappropriate Antibiotic Prescribing Among Primary Care Practices: A Randomized Clinical Trial” by Daniella Meeker, et al. Journal of the American Medical Association. 2016 Feb 9;315(6):562-70. doi: 10.1001/jama.2016.0275.