Behavioral interventions to reduce inappropriate antibiotic prescribing: a randomized pilot trial

Area of Science:

• Infectious Diseases
• Health Informatics
• Behavioral Science

Background:

• Clinicians often inappropriately prescribe antibiotics for acute respiratory infections (ARIs).
• This pilot study aimed to reduce unnecessary antibiotic use in primary care settings.

Purpose of the Study:

• To evaluate the effectiveness of information technology-enabled behavioral interventions in reducing inappropriate antibiotic prescribing for ARIs.
• To test three interventions: Accountable Justifications, Suggested Alternatives, and Peer Comparison in a factorial design.

Main Methods:

• A randomized controlled pilot trial involving primary care clinicians.
• Clinicians were randomized in a 2x2x2 factorial experiment, with an educational module preceding interventions.
• Antibiotic prescribing rates for various ARI diagnoses were measured before and after the intervention period.

Main Results:

• Overall antibiotic prescribing for ARIs decreased significantly from 38.7% to 24.2% (p < 0.001).
• The 'Suggested Alternatives' intervention was associated with reduced prescribing for other respiratory infections (OR, 0.62) and all ARIs combined (OR, 0.72).
• The 'Peer Comparison' intervention was also associated with reduced prescribing for all ARIs combined (OR, 0.73).

Conclusions:

• Significant reductions in antibiotic prescribing were observed, potentially due to Hawthorne effect or clinician contamination.
• Low baseline inappropriate prescribing rates might have limited the ability to detect intervention-specific effects.
• Further research is needed to confirm the efficacy of specific IT-enabled interventions for optimizing antibiotic use.