Study: Small tweaks drop unnecessary antibiotics by 11%

Accreditation Insider, February 16, 2016

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For a long time, antibiotics have been used as a “catch-all” solution to disease. A new study found that certain interventions can reduce the overuse of antibiotics. Overprescribing antibiotics is a bad idea because:

A.    They don’t work on many types of infections, in particular viral infections.
B.    They can cause several negative side effects in patients.
C.    Their overuse has increased the spread of antimicrobial-resistant infections.

The Centers for Disease Control and Prevention (CDC) estimates that 22 million antibiotic prescriptions issued for acute respiratory tract infections (ARTI), including bronchitis and the common cold, are unnecessary and ineffective.

To reduce ineffective prescriptions, researchers performed a behavioral study on physicians at 49 practices in Boston and Los Angeles. The results were published in The Journal of the American Medical Association and found over prescribing could be combated with a few simple “nudges.” 

"Until now, most efforts to reduce antibiotic prescribing have involved education, reminders or giving financial incentives to physicians," study author Jason Doctor, PhD  said in a press release. "We decided to test if socially motivated interventions, such as instilling pride in their performance or making physicians accountable for their decisions, would help address the problem. Our findings here suggest they may." 

Of the three approaches tested, two were found to be extremely effective in lowering prescription rates for acute respiratory infections:

Peer Comparison—Physicians were ranked in terms of how many unnecessary antibiotics they prescribed. The ones with the lowest rates were sent a “Congratulations!” email and the worst performers received an email detailing their unnecessary prescriptions. The email method caused a 16% reduction of antibiotic prescriptions, from 20% to 4%, over 18 months.

Accountable Justification—A simple change in electronic records had the biggest effect on prescription rates. Whenever physicians entered an antibiotic prescription into the electronic record, a prompt would ask them to justify their decision. Their response would then be added to the chart, unless the physician canceled the antibiotics. This change dropped prescription rates by 18% over 18 months.

"There's not a lot of evidence that patients are really demanding antibiotics, but there may be a perception on behalf of physicians that patients won't be satisfied if they don't receive antibiotics," said lead study author Daniella Meeker, PhD. "Also, some clinicians have gotten into the habit of prescribing antibiotics without necessarily ensuring that they may be warranted."

When is it appropriate to prescribe antibiotics for an ARTI? The CDC recently came up with a new set of guidelines to answer that question.

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