Contributed by: Dr. Tamhankar & Siddarth David
A recent study published in the Journal of American Medical Association
showed that behaviour-based interventions showed a marked reduction in inappropriate
prescribing patterns among doctors. It designed a randomized control study. The
target group was divided into three and given one of the following type of
interventions:
1. "Suggested alternatives,” which offered several options to
antibiotic treatment, along with a notation that antibiotics were not indicated
for that diagnosis
2. "Accountable justification," which prompted the physician
to submit a free-text response justifying his or her decision in using
antibiotics
3. "Peer comparison," which is an e-mail sent to doctors
telling them of the performance of the doctors in the study in appropriate prescribing
of antibiotics.
At the end of
the trial, physicians in all the intervention groups had reduced their rates of
inappropriate prescribing. The "suggested alternatives” intervention
lowered their inappropriate prescription rates from 22.1% to 6.1%. Those in the
“accountable justification” group lowered their rates from 23.2% to 5.2%, while
those in the “peer comparison” group lowered their inappropriate prescribing
rates from 19.9% to 3.7%. Physicians in the control group also lowered
overprescribing rates, from 24.1% to 13.1%.
The three interventions
were simple, grounded in behavioral theory, and targeted prescribing at the
point of care. This approach should easily translate across a variety simple methods to
improve antimicrobial stewardship.
