Behavioral 'nudges' help reduce antibiotic prescriptions among physicians

Appealing to clinicians' competitive nature and desires to strengthen their reputations may be an effective method for significantly reducing unnecessary antibiotic prescriptions, according to new research from JAMA.  

"Until now, most efforts to reduce antibiotic prescribing have involved education, reminders or giving financial incentives to physicians," principal investigator and senior author Jason Doctor, PhD, director of health informatics for the University of Southern California Schaeffer Center for Health Policy and Economics in Los Angeles, said in a statement. "We decided to test if socially motivated interventions, such as instilling pride in their performance or making physicians accountable for their decisions, would help address the problem. Our findings here suggest they may."

In an 18-month study, researchers studied intervention strategies that on average reduced inappropriate antibiotic prescriptions for one in eight patients seen. They looked at three interventions, or "nudges," in particular: peer comparison, accountable justification and suggested alternatives.

For the peer comparison component, clinicians received emails ranking them in order among their colleagues from highest to lowest number of antibiotics prescribed, which resulted in a 16 percentage point reduction in prescription rates. Accountable justification, which prompted physicians when they entered patient EHRs to justify their reason for writing a prescription, was the most successful intervention, resulting in an 18 percentage point reduction. For the suggested alternatives intervention, which had no statistically significant effect, a pop-up window would encourage clinicians to use an alternative treatment when recording prescriptions in the computer system.

"Recent clinical guidelines note that increased use of antibiotics is highly correlated with antibiotic-resistant infections and that adverse reactions to antibiotics are implicated in an important subset of visits to emergency departments for adverse drug reactions," Marie Bernard, deputy director of the National Institute on Aging, which funded in the study in part, said in a statement. "This is an area we all need to pay attention to when treating patients of all ages."

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