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Behavioral Interventions Can Cut Inappropriate Antibiotic Use

Significant reductions in rate of inappropriate Rx with accountable justification, peer comparison

TUESDAY, Feb. 9, 2016 (HealthDay News) — Use of certain behavioral interventions can reduce the rates of inappropriate antibiotic prescribing during ambulatory visits for acute respiratory tract infections, according to a study published in the Feb. 9 issue of the Journal of the American Medical Association.

Daniella Meeker, Ph.D., from the University of Southern California in Los Angeles, and colleagues enrolled 248 clinicians from 47 primary care practices and randomly allocated them to receive zero, one, two, or three interventions for 18 months. On enrollment, all clinicians received education on antibiotic prescribing guidelines. The three behavioral interventions included: suggested alternatives, offering nonantibiotic treatments; providing accountable justification for prescribing antibiotics; and peer comparison, comparing antibiotic prescribing rates with those of clinicians with the lowest inappropriate prescribing rates. The authors examined antibiotic prescribing rates for visits with antibiotic-inappropriate acute respiratory tract infections for 18 months pre-intervention (14,753 visits) and 18 months afterward (16,959 visits).

The researchers found that the mean antibiotic prescribing rates decreased from 24.1 to 13.1 percent for control practices; from 22.1 to 6.1 percent for suggested alternatives (P = 0.66); from 23.2 to 5.2 percent for accountable justification (P < 0.001); and from 19.9 to 3.7 for peer comparison (P < 0.001). No significant interactions were seen between interventions.

“Among primary care practices, the use of accountable justification and peer comparison as behavioral interventions resulted in lower rates of inappropriate antibiotic prescribing for acute respiratory tract infections,” the authors write.

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