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The Effect of Expert Feedback on Antibiotic Prescribing in Pediatrics: Experimental Evidence
Kerstin Eilermann1, Katrin Halstenberg2, Ludwig Kuntz3,4
1Cologne Graduate School in Management, Economics, and Social Sciences (CGS), Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany.
Insights
Providing expert feedback to pediatricians significantly reduced antibiotic prescription duration by 10%. This feedback is especially effective for inexperienced physicians, aiding antibiotic stewardship programs in combating antimicrobial resistance.
Area of Science:
- Medical Research
- Public Health
- Pediatrics
Background:
- Inappropriate antibiotic prescribing in pediatric care is a major contributor to antimicrobial resistance.
- Antibiotic stewardship programs recommend provider-specific feedback to mitigate resistance.
- The impact of feedback on physician prescribing and the role of physician characteristics remain under-explored.
Purpose of the Study:
- To investigate the causal effect of descriptive expert feedback on pediatricians' antibiotic prescribing decisions.
- To explore the relationship between physician characteristics and prescribing behavior, as well as responses to feedback.
Main Methods:
- A randomized, controlled framed field experiment was conducted with 73 German pediatricians.
- The intervention group received descriptive expert benchmark feedback on antibiotic treatment length.
- Physician characteristics were collected via a comprehensive questionnaire.
Main Results:
- Expert feedback led to a 10% average reduction in antibiotic therapy length.
- The deviation of pediatricians' decisions from expert recommendations significantly decreased.
- Prescribing decisions were influenced by clinical experience, risk attitudes, and personality traits; feedback effectiveness correlated with experience.
Conclusions:
- Descriptive expert feedback is an effective tool for guiding pediatricians towards appropriate antibiotic prescribing.
- The intervention shows particular promise for inexperienced physicians.
- This feedback mechanism is suitable for integration into antibiotic stewardship programs to combat antimicrobial resistance.
Abstract:
Background. Inappropriate prescribing of antibiotics, which is common in pediatric care, is a key driver of antimicrobial resistance. To mitigate the development of resistance, antibiotic stewardship programs often suggest the inclusion of feedback targeted at individual providers. Empirically, however, it is not well understood how feedback affects individual physicians' antibiotic prescribing decisions. Also, the question of how physicians' characteristics, such as clinical experience, relate to antibiotic prescribing decisions and to responses to feedback is largely unexplored. Objective. To analyze the causal effect of descriptive expert feedback (and individual characteristics) on physicians' antibiotic prescribing decisions in pediatrics. Design. We employed a randomized, controlled framed field experiment, in which German pediatricians (n=73) decided on the length of first-line antibiotic treatment for routine pediatric cases. In the intervention group (n=39), pediatricians received descriptive feedback in form of an expert benchmark, which allowed them to compare their own prescribing decisions with expert recommendations. The recommendations were elicited in a survey of pediatric department directors (n=20), who stated the length of antibiotic therapies they would choose for the routine cases. Pediatricians' characteristics were elicited in a comprehensive questionnaire. Results. Providing pediatricians with expert feedback significantly reduced the length of antibiotic therapies by 10% on average. Also, the deviation of pediatricians' decisions from experts' recommendations significantly decreased. Antibiotic therapy decisions were significantly related to pediatricians' clinical experience, risk attitudes, and personality traits. The effect of feedback was significantly associated with physicians' experience. Conclusion. Our results indicate that descriptive expert feedback can be an effective means to guide pediatricians, especially those who are inexperienced, toward more appropriate antibiotic prescribing. Therefore, it seems to be suitable for inclusion in antibiotic stewardship programs.
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