Single Health System RCT Addressing Corticosteroid Injection Use in Treating Adults with ARTIs

Systemic corticosteroids are frequently used inappropriately to treat patients with acute respiratory tract illnesses (ARTI) despite a lack of efficacy and risks.

To develop an intervention which effectively decreases corticosteroid use for ARTI encounters among outpatient clinicians.

A randomized controlled trial in which the clinicians in primary care clinics that were randomized to intervention clinics were compared to clinicians in control group clinics. The 6-month trial began in March 2023.

Outpatient primary care clinics within Southeast Louisiana.

High steroid utilizing clinicians with ≥5% baseline ARTI steroid injection rate caring for outpatient adults.

Intervention clinicians were assigned a voluntary 1-h online course and received a monthly personalized report of their steroid usage.

Monthly office visits with at least one ARTI diagnosis were evaluated for the rate of corticosteroid injection use. The effect of the intervention was assessed by a negative binomial regression model accounting for the repeated nature of the data collection.

Sixty-one clinicians in the control clinic group and 75 in the intervention clinic group were identified as high-utilizing clinicians. At baseline, intervention and control clinicians' average inappropriate steroid injection rates were similar: 16 and 15%, respectively. Steroid injection use among intervention clinicians decreased significantly compared to controlled clinicians (5.5 (95% CI 3.8, 7.9) vs. 10.7 (95% CI 7.7, 14.8) per 100 patients; p = 0.03) - resulting in nearly a 50% reduction in inappropriate use.

This innovative implementation study showed a clinically and statistically significant improvement in decreasing inappropriate steroid use. Our work helps lay the groundwork to advance adopting inappropriate corticosteroid use as a primary care and ARTI care quality metric.