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Single Health System RCT Addressing Corticosteroid Injection Use in Treating Adults with ARTIs
Evan L Dvorin1, Mariella Gastanaduy2, Marissa Scott2,3
1Primary Care and Wellness, Ochsner Health, New Orleans, LA, USA. edvorin@ochsner.org.
Journal of General Internal Medicine
|October 30, 2025
Summary
An online course and monthly reports significantly reduced inappropriate corticosteroid use for acute respiratory tract illnesses (ARTI) by nearly 50% in outpatient clinicians. This intervention improves ARTI care quality.
Area of Science:
- Primary Care Medicine
- Clinical Implementation Science
- Health Services Research
Background:
- Systemic corticosteroids are often inappropriately prescribed for acute respiratory tract illnesses (ARTI), despite evidence of limited efficacy and potential risks.
- High rates of inappropriate corticosteroid prescribing contribute to suboptimal patient outcomes and increased healthcare costs.
Purpose of the Study:
- To develop and evaluate an intervention aimed at reducing the inappropriate use of corticosteroids by outpatient clinicians treating patients with ARTI.
- To assess the effectiveness of a multifaceted intervention including online education and personalized feedback on clinician prescribing patterns.
Main Methods:
- A randomized controlled trial was conducted across outpatient primary care clinics in Southeast Louisiana.
- High-steroid-utilizing clinicians treating adults with ARTI were randomized into intervention or control groups.
- The intervention group received a voluntary online course and monthly personalized reports on their steroid usage, with outcomes assessed over six months using negative binomial regression.
Main Results:
- The intervention led to a significant decrease in corticosteroid injection rates among intervention clinicians compared to control clinicians (5.5 vs. 10.7 per 100 patients).
- This reduction represents nearly a 50% decrease in inappropriate corticosteroid use in the intervention group.
- The study included 61 clinicians in the control group and 75 in the intervention group, with similar baseline inappropriate steroid injection rates (15-16%).
Conclusions:
- The implemented intervention demonstrated a clinically and statistically significant reduction in inappropriate corticosteroid prescribing for ARTI.
- This study provides a foundation for establishing inappropriate corticosteroid use as a quality metric in primary care and ARTI management.
- The findings support the adoption of targeted educational and feedback strategies to improve prescribing practices in outpatient settings.
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