Featured Research

from universities, journals, and other organizations

Health care savings: Reducing inappropriate antibiotic prescriptions

Date:
January 27, 2014
Source:
University of Southern California
Summary:
Despite widely accepted prescription guidelines, physicians continue to prescribe antibiotics for colds even when they won't help. A new study offers an inexpensive and seemingly simple "nudge" that reduced inappropriate antibiotic prescribing by nearly 20 percent.

Inappropriate antibiotic prescriptions are a major public health concern, costing millions of dollars in unnecessary health care costs annually and contributing to the problem of antibiotic-resistant bacteria. Still, despite widely accepted prescription guidelines, physicians continue to prescribe antibiotics for colds even when they won't help. A new study in JAMA Internal Medicine to be released January 27 offers an inexpensive and seemingly simple "nudge" that reduced inappropriate antibiotic prescribing by nearly 20 percent.

In the United States, nearly half the antibiotic prescriptions given for respiratory infections are inappropriate: for illnesses caused by viruses rather than bacteria, antibiotics won't help the patient get better. The study is part of a critical national conversation led by researchers at the USC Schaeffer Center for Health Policy and Economics to find evidence-based interventions that lower health care costs and unnecessary use of health care.

"Most quality improvement efforts have used audits or pay-for-performance incentives to try to change what providers do, but they ignore social influences that affect all people, including physicians," said senior author Jason Doctor of the USC Schaeffer Center for Health Policy and Economics, and associate professor of clinical pharmacy and pharmaceutical economics and policy at the USC School of Pharmacy. "Our study is the first to apply the principles of commitment and consistency to prescribing behavior and finds a simple, low-cost intervention that shows great promise in reducing inappropriate antibiotic prescription."

Lead author Daniella Meeker of RAND Corporation and Merkin Fellow at the USC Schaeffer Center for Health Policy and Economics; Jeffrey A. Linder, an expert in antibiotic prescribing at Brigham and Women's Hospital and Harvard Medical School; Doctor and the other authors, estimate that their simple intervention -- a prominently displayed commitment letter -- could eliminate 2.6 million unnecessary antibiotic prescriptions and save $70.4 million in drug costs alone if extrapolated across the United States.

The study

To test the impact of public commitment on health behavior, the researchers had physicians post a large letter about inappropriate antibiotic prescription in their exam rooms. The letter, displayed in both English and Spanish in Los Angeles clinics, had a picture of the physician and his/her signature, and explained the physician's commitment to reducing inappropriate prescriptions for acute respiratory infections, such as the common cold.

The researchers then looked at clinic records over the next three months, comparing rates of inappropriate antibiotic prescriptions to a control group that did not sign or post a public commitment poster.

The results

A signed commitment poster dramatically decreased unnecessary antibiotic prescriptions: among physicians who posted the letter, inappropriate antibiotic prescriptions fell nearly 10 percentage points, to 33.7 percent of total antibiotic prescriptions from 42.8 percent in the year before the study.

In contrast, inappropriate antibiotic prescriptions actually increased in the control group, who started with a similar 43.5 percent inappropriate prescription rate. Over the study period, the prescription of antibiotics in instances where they would not be effective rose to 52.7 percent among those who did not post a commitment poster.

Importantly, rates of appropriate antibiotic prescription did not change, the researchers found. There also was no evidence of changes to how illnesses or diagnoses were coded by clinicians.

"The findings from the study support the idea that clinicians are influenced by professional and social factors in patient care, and unlike some quality improvement interventions based upon financial incentives, we found no evidence that improvements were driven by changing documentation practices. This low-cost and easily scalable intervention has great potential to reduce inappropriate antibiotic prescribing," Meeker said.

"This intervention is a unique addition to interventions that have decreased inappropriate antibiotic prescribing for respiratory infections. Most other interventions have been focused on reminders or education and this is a novel, low-cost approach," Linder said.

The study did not look at why physicians might be inclined to overprescribe antibiotics, but possible explanations from other research include patient demand and "defensive" prescribing.

"The results move beyond educational posters, showing how public commitments and active engagement can prompt greater personal motivation to perform a behavior, in this case reversing a tendency to prescribe antibiotics when they are not effective," Doctor said.


Story Source:

The above story is based on materials provided by University of Southern California. Note: Materials may be edited for content and length.


Journal Reference:

  1. Daniella Meeker, PhD et al. Nudging Guideline-Concordant Antibiotic PrescribingA Randomized Clinical Trial. JAMA Internal Medicine, January 2014

Cite This Page:

University of Southern California. "Health care savings: Reducing inappropriate antibiotic prescriptions." ScienceDaily. ScienceDaily, 27 January 2014. <www.sciencedaily.com/releases/2014/01/140127164803.htm>.
University of Southern California. (2014, January 27). Health care savings: Reducing inappropriate antibiotic prescriptions. ScienceDaily. Retrieved April 16, 2014 from www.sciencedaily.com/releases/2014/01/140127164803.htm
University of Southern California. "Health care savings: Reducing inappropriate antibiotic prescriptions." ScienceDaily. www.sciencedaily.com/releases/2014/01/140127164803.htm (accessed April 16, 2014).

Share This



More Health & Medicine News

Wednesday, April 16, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Could Even Casual Marijuana Use Alter Your Brain?

Could Even Casual Marijuana Use Alter Your Brain?

Newsy (Apr. 16, 2014) A new study conducted by researchers at Northwestern and Harvard suggests even casual marijuana use can alter your brain. Video provided by Newsy
Powered by NewsLook.com
Thousands Of Vials Of SARS Virus Go Missing

Thousands Of Vials Of SARS Virus Go Missing

Newsy (Apr. 16, 2014) A research institute in Paris somehow misplaced more than 2,000 vials of the deadly SARS virus. Video provided by Newsy
Powered by NewsLook.com
Formerly Conjoined Twins Released From Dallas Hospital

Formerly Conjoined Twins Released From Dallas Hospital

Newsy (Apr. 16, 2014) Conjoined twins Emmett and Owen Ezell were separated by doctors in August. Now, nearly nine months later, they're being released from the hospital. Video provided by Newsy
Powered by NewsLook.com
Ebola Outbreak Now Linked To 121 Deaths

Ebola Outbreak Now Linked To 121 Deaths

Newsy (Apr. 15, 2014) The ebola virus outbreak in West Africa is now linked to 121 deaths. Health officials fear the virus will continue to spread in urban areas. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins