Appropriate antimicrobial prescribing improves when physician autonomy is preserved, study shows

A behavioral approach focused on preserving physician autonomy and participation helps enhance the appropriateness of antimicrobial prescribing in hospitals, according to a study in JAMA Internal Medicine.

The study, conducted by Dutch researchers from Oct. 1, 2011, through Dec. 31, 2015, included seven clinical departments in a tertiary care medical center and a general teaching hospital in The Netherlands. Researchers assessed 1,121 patient cases with 700 antimicrobial prescriptions before the approach was implemented. They assessed 882 patient cases with 531 antimicrobial prescriptions during the intervention period.

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The behavioral intervention involved offering prescribers a free choice of how to improve their antimicrobial prescribing. Prescribers were urged to choose improvements with higher potential for success based on a root cause analysis of inappropriate prescribing.

The study shows that mean antimicrobial appropriateness increased from 64.1 percent at beginning of the intervention implementation to 77.4 percent at the 12-month follow-up, a jump of 13.3 percent. Researchers did not identify a decrease in antimicrobial consumption.

"Use of a behavioral approach preserving prescriber autonomy resulted in an increase in antimicrobial appropriateness sustained for at least 12 months. The approach is inexpensive and could be easily transferable to various healthcare environments," study authors concluded.

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