Investigating the know-do gap in antibiotics prescribing: Experimental evidence from India

Area of Science:

• Global Health
• Infectious Diseases
• Health Policy

Background:

• Antimicrobial resistance (AMR) is a significant global health threat, largely driven by antibiotic overuse.
• Low- and middle-income countries face particular challenges with antibiotic overuse, especially in pediatric care.
• Understanding the drivers of antibiotic overprescribing is crucial for developing effective interventions.

Purpose of the Study:

• To investigate the reasons behind antibiotic overprescribing for pediatric diarrhea in India.
• To identify effective strategies for reducing unnecessary antibiotic prescriptions.

Main Methods:

• Combined provider knowledge assessments with over 2000 anonymous standardized patient visits in India.
• Utilized randomized experiments to test the impact of addressing provider beliefs.
• Conducted a discrete choice experiment to understand patient preferences.

Main Results:

• Seventy percent of providers prescribed antibiotics without clear indication of bacterial infection.
• Knowledge gaps explained little; a significant "know-do gap" persisted.
• Addressing provider misperceptions about patient preferences reduced prescribing by 30 percentage points, far exceeding the impact of perfect knowledge.

Conclusions:

• Provider misperceptions regarding patient preferences are a primary driver of antibiotic overprescribing for pediatric diarrhea.
• Interventions targeting these misperceptions may be more effective than traditional information-based approaches.
• Reducing antibiotic overuse requires addressing the behavioral drivers beyond simple knowledge deficits.