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<0.001). There were no significant relationships between any intervention and antibiotic prescribing for non-antibiotic-appropriate ARI diagnoses or sinusitis/pharyngitis. Suggested Alternatives was associated with reduced antibiotic prescribing for other diagnoses or symptoms of respiratory infection (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.44-0.89) and for all ARI categories combined (OR, 0.72; 95% CI, 0.54-0.96). Peer Comparison was associated with reduced prescribing for all ARI categories combined (OR, 0.73; 95% CI, 0.53-0.995). Conclusions: We observed large reductions in antibiotic prescribing regardless of whether or not study participants received an intervention, suggesting an overriding Hawthorne effect or possibly clinician-to-clinician contamination. Low baseline inappropriate prescribing may have led to floor effects. Trial Registration: ClinicalTrials.gov: NCT01454960.
Original language | English (US) |
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Article number | 373 |
Journal | BMC Infectious Diseases |
Volume | 16 |
Issue number | 1 |
DOIs | |
State | Published - Aug 5 2016 |
Funding
Dr. Persell receives unrelated research grant support from Pfizer, Inc. There are no other potential competing interests to report.
Keywords
- Acute respiratory infections
- Antibiotics
- Behavioral economics
- Clinical decision support
- Social psychology
ASJC Scopus subject areas
- Infectious Diseases
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Behavioral interventions to reduce inappropriate antibiotic prescribing: a randomized pilot trial
Persell, S. D. (Creator), Doctor, J. N. (Creator), Friedberg, M. W. (Creator), Meeker, D. (Creator), Friesema, E. (Creator), Cooper, A. (Creator), Haryani, A. (Creator), Gregory, D. L. (Contributor), Fox, C. R. (Creator), Goldstein, N. J. (Creator) & Linder, J. A. (Creator), figshare, 2016
DOI: 10.6084/m9.figshare.c.3627788, https://figshare.com/collections/Behavioral_interventions_to_reduce_inappropriate_antibiotic_prescribing_a_randomized_pilot_trial/3627788
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Additional file 2: of Behavioral interventions to reduce inappropriate antibiotic prescribing: a randomized pilot trial
Persell, S. D. (Creator), Doctor, J. N. (Creator), Friedberg, M. W. (Creator), Meeker, D. (Creator), Friesema, E. (Creator), Cooper, A. (Creator), Haryani, A. (Creator), Gregory, D. L. (Contributor), Fox, C. R. (Creator), Goldstein, N. J. (Creator) & Linder, J. A. (Creator), figshare, 2016
DOI: 10.6084/m9.figshare.c.3627788_d2, https://springernature.figshare.com/articles/presentation/Additional_file_2_of_Behavioral_interventions_to_reduce_inappropriate_antibiotic_prescribing_a_randomized_pilot_trial/4414007
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