Antibiotic Overprescribing Increased After Program Monitoring Doctors Stopped: Study

Following implementation of a doctor monitoring program, rates of antibiotic overprescribing initially decreased, but then rates increased after the program ended, according to the findings of new research designed to look at ways to reduce the risk of antibiotic resistant infections in the community. 

In a study published this week in the Journal of the American Medical Association (JAMA), researchers noted that antibiotic prescription monitoring programs were effective, but recommend that institutions looking to influence prescribing decisions should consider applying the efforts long-term.

Researchers conducted a cluster-randomized trial of three behavioral interventions implemented at 47 primary care practices in Boston, Massachusetts, and Los Angeles, California. The study enrolled nearly 250 doctors, who were either part of the control, or received one of three interventions for 18 months.

Two of the three interventions were successful in helping to reduce the rate of antibiotic overprescribing, which have been linked to the emergence of dangerous “superbug” infections, which are often difficult to treat since some bacteria has become resistant to existing drugs.

Initially, all doctors received education on proper antibiotic prescribing guidelines. Then they were offered one of three interventions, two of which used electronic health records to help implement the changes.

The first intervention offered doctors suggestions for alternative non-antibiotic treatments when doctors tried to prescribe antibiotics for acute respiratory infections.

The second prompted doctors to enter “free-text” justifications in the electronic records to describe why antibiotics were being given for acute respiratory infections.

Finally, doctors were offered peer comparisons. They were sent monthly emails comparing their inappropriate antibiotic prescribing rates for respiratory infections to other doctors with the lowest prescribing rates. Acute respiratory infections, included nonspecific upper respiratory tract infections, acute bronchitis and influenza.

Overall, the justification program and peer comparison interventions significantly reduced inappropriate antibiotic prescribing at the end of the intervention period.

After the intervention period, the rates of inappropriate prescribing increased for every intervention program, but not for the control clinics. Control clinics saw a decrease in inappropriate antibiotic prescribing from 14% to 11.8% after the study.

While doctors who took part in the interventions had increased antibiotic prescribing after, their rates were still lower than the control clinics.

Doctors who were a part of the alternative suggestions group saw an increase from 7.4% to 8.8%. Those who were a part of the accountable justification program saw an increase from 6.1% to 10.2% and those who were a part of the peer comparison group increased from 4.8% to 6.3%.

Even the group with the highest rates, still had rates lower than the control group.

A report published in September indicated the number of antibiotic prescriptions is indeed decreasing. Blue Cross Blue Shield reported a decrease in antibiotic prescriptions by 9%, signaling perhaps doctors are beginning to heed warnings concerning antibiotic overuse.

Researchers said peer comparisons may have been effective after the study period because they allowed doctors to make “judicious prescribing” a permanent part of their professional self image.