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

BMC Infectious Diseases

Research Article

Craig R. Fox¹  Noah J. Goldstein¹  Dyanna L. Gregory²  Andrew Cooper²  Ajay Haryani²  Elisha Friesema³  Stephen D. Persell³  Jeffrey A. Linder⁴  Mark W. Friedberg⁵  Jason N. Doctor⁶  Daniella Meeker⁷ 

[1] Department of Psychology, UCLA Anderson School of Management; David Geffen School of Medicine at UCLA, UCLA, 110 Westwood Plaza D-511, 90095, Los Angeles, CA, USA;Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, 60611, Chicago, IL, USA;Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, 60611, Chicago, IL, USA;Center for Primary Care Innovation, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, 60611, Chicago, IL, USA;Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital; Harvard Medical School, 1620 Tremont Street, BC-3-2X, 02120, Boston, MA, USA;Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital; Harvard Medical School, 1620 Tremont Street, BC-3-2X, 02120, Boston, MA, USA;RAND, 20 Park Plaza, Suite 920, 02116, Boston, MA, USA;USC Schaeffer Center for Health Policy and Economics, University of Southern California, 3335 S. Figueroa Street, Unit A, 90089-7273, Los Angeles, CA, USA;USC Schaeffer Center for Health Policy and Economics, University of Southern California, 3335 S. Figueroa Street, Unit A, 90089-7273, Los Angeles, CA, USA;RAND, 1776 Main St., 90401, Santa Monica, CA, USA;

关键词: Antibiotics;    Acute respiratory infections;    Behavioral economics;    Social psychology;    Clinical decision support;   

DOI  :  10.1186/s12879-016-1715-8

 received in 2015-08-27, accepted in 2016-07-13,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundClinicians 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.MethodsPrimary 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.ResultsWe 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).ConclusionsWe 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 RegistrationClinicalTrials.gov: NCT01454960.

【 授权许可】

CC BY   
© The Author(s). 2016