Antibiotic Overuse Curbed When Doctors Use Peer Comparisons, Justifications: Study

Serious health concerns have been raised about the widespread overprescription of antibiotics by doctors throughout the U.S., often for conditions that can’t be treated by antibiotics. However, a new study suggests that unnecessary prescriptions dropped when doctor’s choices were scrutinized or run past their peers. 

Researchers from the University of Southern California, Los Angeles, indicate that inappropriate antibiotic use dropped more than 16% by introducing behavioral interventions to primary care practices. The findings were published online Feb. 9, in The Journal of the American Medical Association.

The study looked at data on 47 primary care practices in Boston and Los Angeles, enrolling 248 doctors into one of three randomized interventions for 18 months, or no intervention as a control. Doctors received interventions between November 1, 2011, to October 1, 2012, with follow-up by April 1, 2014.

Interventions included suggesting alternatives with non-antibiotic treatments, accountable justification where doctors were prompted to enter justifications for prescribing antibiotics into patients’ electronic health records, and peer comparison where emails were sent to doctors that compared their antibiotic prescribing rates with the rates of doctors with the lowest inappropriate prescribing rates, known as “top performers.”

Inappropriate prescribing was described as giving antibiotics for nonspecific upper respiratory tract infections, acute bronchitis or influenza, which are conditions that antibiotics do not treat.

Such overuse of antibiotics is believed to be a major contributor to the increasing development of antibiotic-resistant bacteria, or so-called “superbugs.”

More than 30,000 visits were tracked during both the baseline and intervention periods for the new study. Nearly 70% of the patients were female.

Interventions Make Doctors Reconsider Antibiotic Use

On average antibiotic prescribing rates decreased from 24% at intervention start, to 13% by intervention month 18. When doctors implemented accountable justification, antibiotic prescribing rates dropped from 23% to five percent.

The intervention allows doctors to type text into electronic health records justifying the need for the prescription. This presumably calls on clinicians to offer legitimate reasons for prescribing practices, instead of frequently offering antibiotics for any ailment.

When doctors implemented the peer comparison intervention, antibiotic prescribing rates dropped from nearly 20% down to 3.7% .

During peer comparison intervention, clinicians were sent regular emails that compared their antibiotic prescribing rates with the rates of doctors with the lowest inappropriate prescribing rates. In this way doctors may put their practices in perspective compared to other doctors, potentially calling on them to be more stringent during prescribing.

“Use of accountable justification and peer comparison as behavioral interventions resulted in lower rates of inappropriate  antibiotic prescribing for acute respiratory  tract infections,” wrote study authors.