Interventions Cut Inappropriate Antibiotic Prescribing

InterAccountable justification and peer comparison behavioral interventions help clinicians reduce inappropriately prescribing antibiotics to patients with acute respiratory tract infections, according to a new study.

Although prescribing guidelines are available that caution against the prescription of antibiotics to patients with respiratory symptoms, researchers wanted to examine whether behavioral interventions could also help to lower the rate of inappropriate antibiotic prescribing.
______________________________________________________________________________________________________________________________________________________________________

RELATED CONTENT
New Guidelines Discourage Antibiotic Use in Sinus Infections
New Antibiotic Will Better Fight Super Bugs
______________________________________________________________________________________________________________________________________________________________________

In a randomized clinical trial, researchers followed 248 clinicians practicing in 47 clinics in Boston and Los Angeles. From November 2011 to October 2012, clinicians were given 0, 1, 2, or 3 interventions over 18 months.

Behavioral interventions, given separately or in combination, included (1) suggested alternatives, which suggested treatments other than antibiotics; (2) accountable justification, which allowed clinicians to justify prescribing antibiotics in an open-ended text box in the patient’s electronic health record; and (3) peer comparison, which sent an email to their peer clinicians comparing prescription rates.

At baseline, clinicians were informed of antibiotic prescribing guidelines.

After analyzing the data in 2014, researchers found that inappropriate antibiotic prescribing declined from 22% at baseline to 6% after 18 months when using suggested alternatives, from 23% to 5% when using accountable justification, and from 20% to 4% when using peer comparison.

“Among primary care practices, the use of accountable justification and peer comparison as behavioral interventions resulted in lower rates of inappropriate antibiotic prescribing for acute respiratory tract infections.”

—Amanda Balbi

Reference:

Meeker D, Linder JA, Fox CR, et al. Effect of behavioral interventions on inappropriate antibiotic prescribing among primary care practices: A randomized clinical trial. JAMA. 2016;315(6):562-570. doi:10.1001/jama.2016.0275.