Social motivation, peer comparisons may help reduce inappropriate antibiotic prescribing
NEW ORLEANS – Clinicians told in an email how they compared to other clinicians performing the same task were more likely to follow prescription writing guidelines, according to a presentation at IDWeek 2016.
Jeffrey Linder, MD, MPH, of Brigham & Women’s Hospital and Harvard Medical School and colleagues evaluated three interventions: “accountable justifications,” where clinicians entered their personal justification for prescription writing; “peer comparisons,” where clinicians received monthly emails showing how they fared alongside top performers, and “suggested alternatives,” where clinicians received electronic order sets suggesting non-antibiotic treatments. The three interventions were implemented either alone or in combination in patients with influenza, acute bronchitis and nonspecific upper respiratory tract infections.
“We saw a persistent significant change in antibiotic prescribing in the peer comparison intervention group,” Linder told attendees. “The traditional clinical decision support that first suggested alternatives seemed less persistent …. Interventions that take advantage of social motivation appear to be effective or persistent.”
When compared to a control group, the rate of changes by the “peer comparison” group retained its statistical significance, while the rate in the “suggested alternatives” and “accountable justification” groups went down, albeit nonsignificantly, Linder noted.
“A limitation and a strength is we only have 18 months of follow-up,” Linder said. “Who knows what’s going to happen off in the future, although this was a randomized, controlled trial. It was big, it was done in three health systems with three different [electronic health record systems].”
According to an abstract published before IDWeek 2016, during the 18-month intervention period, there were 16,959 antibiotic-inappropriate visits to 245 clinicians, for an adjusted antibiotic rate of 17% (95% CI, 14-21). During a 5-month post-intervention period, there were 3,192 antibiotic-inappropriate visits to 224 clinicians, for an adjusted antibiotic prescribing rate of 15% (95% CI, 11-19).
Broken down by intervention type, there were no significant changes in the adjusted antibiotic prescribing rate for each of the three interventions during the 18-month intervention period and during the 5-month post-intervention period.
Reference: Linder J, et al. Durability of benefits of behavioral interventions on inappropriate antibiotic prescribing in primary care: follow-up from a cluster randomized clinical trial. Presented at 2016 ID Week; Oct. 26-30; New Orleans.
Disclosure: Healio Family Medicine was unable to confirm relevant financial disclosures prior to publication.