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Thursday, February 18, 2016

Inappropriate prescribing can be reduced by Behavioural Interventions

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.