Persell, Stephen D.Doctor, Jason N.Friedberg, Mark W.Meeker, DaniellaFriesema, ElishaCooper, AndrewHaryani, AjayGregory, Dyanna L.Fox, Craig R.Goldstein, Noah J.Linder, Jeffrey A2016-10-112016Persell, 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/s12879-016-1715-8.1471-2334http://nrs.harvard.edu/urn-3:HUL.InstRepos:29002525Background: 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.en-USAntibioticsAcute respiratory infectionsBehavioral economicsSocial psychologyClinical decision supportJournal Article2016-10-1110.1186/s12879-016-1715-8