Inappropriate antibiotic prescribing contributes to antibiotic resistance and leads to adverse events. A randomized trial of three behavioral interventions intended to reduce inappropriate prescribing found that 2 of the 3 interventions were effective. Jason N. Doctor, Ph.D., of the University of Southern California, Los Angeles, examined the persistence of effects 12 months after stopping the interventions. The researchers randomized 47 primary care practices in Boston and Los Angeles and enrolled 248 clinicians to receive 0, 1, 2, or 3 interventions for 18 months. All clinicians received education on antibiotic prescribing guidelines.
‘During the post-intervention period, the rate of inappropriate antibiotic prescribing decreased in control clinics but increased for the different types of interventions.’
The authors found that during the post-intervention period, the rate of inappropriate antibiotic prescribing decreased in control clinics from 14.2 percent to 11.8 percent, and for the different types of interventions, it increased from 7.4 percent to 8.8 percent for suggested alternatives; increased from 6.1 percent to 10.2 percent for accountable justification; and increased from 4.8 percent to 6.3 percent for peer comparison. During the post-intervention period, peer comparison remained lower than control, whereas accountable justification was not different from control.
Limitations of the study are that it only included volunteering clinicians from selected practices, and the post-intervention follow-up was only 12 months.
"These findings suggest that institutions exploring behavioral interventions to influence clinician decision-making should consider applying them long-term," the authors write.