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

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

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Title: Behavioral interventions to reduce inappropriate antibiotic prescribing: a randomized pilot trial
Author: Persell, Stephen D.; Doctor, Jason N.; Friedberg, Mark W.; Meeker, Daniella; Friesema, Elisha; Cooper, Andrew; Haryani, Ajay; Gregory, Dyanna L.; Fox, Craig R.; Goldstein, Noah J.; Linder, Jeffrey A.

Note: Order does not necessarily reflect citation order of authors.

Citation: Persell, S. D., J. N. Doctor, M. W. Friedberg, D. Meeker, E. Friesema, A. Cooper, A. Haryani, et al. 2016. “Behavioral interventions to reduce inappropriate antibiotic prescribing: a randomized pilot trial.” BMC Infectious Diseases 16 (1): 373. doi:10.1186/s12879-016-1715-8. http://dx.doi.org/10.1186/s12879-016-1715-8.
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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. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1715-8) contains supplementary material, which is available to authorized users.
Published Version: doi:10.1186/s12879-016-1715-8
Other Sources: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4975897/pdf/
Terms of Use: This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA
Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:29002525
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