Behavioral interventions to reduce inappropriate antibiotic prescribing: a randomized pilot trial

  • Stephen D Persell (Creator)
  • Jason N. Doctor (Creator)
  • Mark W. Friedberg (Creator)
  • Daniella Meeker (Creator)
  • Elisha M. Friesema (Creator)
  • Andrew Cooper (Creator)
  • Ajay Haryani (Creator)
  • Dyanna L. Gregory (Contributor)
  • Craig R. Fox (Creator)
  • Noah J. Goldstein (Creator)
  • Jeffrey A Linder MD MPH (Creator)



Abstract Background Clinicians frequently prescribe antibiotics inappropriately for acute respiratory infections (ARIs). Our objective was to test information technology-enabled behavioral interventions to reduce inappropriate antibiotic prescribing for ARIs in a randomized controlled pilot test trial. Methods Primary care clinicians were randomized in a 2 × 2 × 2 factorial experiment with 3 interventions: 1) Accountable Justifications; 2) Suggested Alternatives; and 3) Peer Comparison. Beforehand, participants completed an educational module. Measures included: rates of antibiotic prescribing for: non-antibiotic-appropriate ARI diagnoses, acute sinusitis/pharyngitis, all other diagnoses/symptoms of respiratory infection, and all three ARI categories combined. Results We examined 3,276 visits in the pre-intervention year and 3,099 in the intervention year. The antibiotic prescribing rate fell for non-antibiotic-appropriate ARIs (24.7 % in the pre-intervention year to 5.2 % in the intervention year); sinusitis/pharyngitis (50.3 to 44.7 %); all other diagnoses/symptoms of respiratory infection (40.2 to 25.3 %); and all categories combined (38.7 to 24.2 %; all p 
Date made available2016

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