November 20, 2017
Behavioral interventions to reduce inappropriate prescribing may be best applied over the long term, according to a research letter published in JAMA (doi:10.1001/jama.2017.11152).
Researchers found that interventions that decreased inappropriate antibiotic prescribing among primary care providers worked for a time, but when they ceased, their effect diminished.
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“In the 12 months after removing behavioral interventions, inappropriate antibiotic prescribing for acute respiratory infections increased relative to control practices — whose inappropriate prescribing rates continued to decrease,” researchers wrote.
The study involved 248 providers at 47 primary care practices randomized to receive as many as 3 interventions over 18 months geared to reduce inappropriate antibiotic prescribing. While providers randomized to a control group received no interventions, all participants received education on antibiotic prescribing guidelines.
Behavioral interventions consisted of:
- order sets on the electronic health record (EHR) that provided nonantibiotic treatment suggestions when a provider attempted to prescribe an antibiotic for an acute respiratory infection,
- a prompt that required providers to write a free-text justification when prescribing an antibiotic for an acute respiratory infection, and
- monthly emails that compared a provider’s inappropriate antibiotic prescribing for acute respiratory infections with providers who had the lowest rates.
The latter 2 interventions (accountable justification and peer comparison, respectively) significantly decreased inappropriate antibiotic prescribing by the end of the intervention period, researchers wrote. However, during the postintervention period, rates of inappropriate antibiotic prescribing climbed.
Only the peer comparison email intervention, researchers reported, had a statistically significant decrease compared with the control group 12 months after the intervention stopped.
“[T]his intervention did not rely on EHR prompts whose absence might have been quickly noted by clinicians,” researchers reasoned. “Peer comparison might also have led clinicians to make judicious prescribing part of their self-image.”
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