Behavioral Intervention Reduces Inappropriate Antibiotic Prescribing

WASHINGTON, D.C. — 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. Plus, overprescription is a significant cause of population-level antibiotic resistance.

In a randomized clinical trial, funded by the National Institute on Aging, involving 248 primary-care clinicians, Dr. Jason 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{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} 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{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}.

• 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{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} decrease in inappropriate prescriptions.

Over the 18-month intervention period, the overall number of inappropriate antibiotic prescriptions decreased by 11{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} 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.