Removing Behavioral Interventions May Up Inappropriate Antibiotic Prescribing

HealthDay News — Inappropriate antibiotic prescribing for acute respiratory infections (ARIs) increases in the 12 months after removing behavioral interventions compared with control practices, according to a research letter published online October 10 in the Journal of the American Medical Association.

Jeffrey A. Linder, MD, MPH, from Northwestern University Feinberg School of Medicine in Chicago, and colleagues randomized 47 primary care practices and enrolled 248 clinicians to receive 0, 1, 2, or 3 behavioral interventions (suggested alternatives, accountable justification, and peer comparison) for 18 months, with the aim of reducing inappropriate antibiotic prescriptions. The researchers examined the persistence of effects 12 months after stopping the interventions. 

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During the baseline, intervention, and post-intervention periods, there were 14,753, 16,959, and 7,489 visits for antibiotic-inappropriate ARIs. The researchers found that the rate of inappropriate antibiotic prescribing decreased in control clinics from 14.2 to 11.8% during the post-intervention period (absolute difference, −2.4%). It increased from 7.4 to 8.8% (absolute difference, 1.4%) for suggested alternatives (difference-in-differences, 3.8% [95% confidence interval, −10.3 to 17.9%]; P=0.55), increased from 6.1 to 10.2% (absolute difference, 4.1%) for accountable justification (difference-in-differences, 6.5% [95% confidence interval, 4.2 to 8.8%]; P<0.001), and increased from 4.8 to 6.3% (absolute difference, 1.5%) for peer comparison (difference-in-differences, 3.9% [95 percent confidence interval, 1.1 to 6.7%]; P<0.005). Peer comparison remained lower than control (P<0.001; 1-tailed test) during the post-intervention period, while there was no difference for accountable justification versus control (P=0.99; 1-tailed test).

“These findings suggest that institutions exploring behavioral interventions to influence clinician decision making should consider applying them long-term,” the authors write.

Several authors disclosed ties to the pharmaceutical and health care consulting industries.

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