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Too Many Unnecessary Antibiotic Prescriptions Issued — USC Study PDF Print E-mail
Written by San Fernando Valley Sun   
Thursday, 30 January 2014 01:56

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 USC study published in JAMA Internal Medicine suggests an inexpensive and seemingly simple “nudge” that reduced such inappropriate prescribing by 20 percent. According to researchers at the USC Schaeffer Center for Health Policy and Economics, nearly half the antibiotic prescriptions written for respiratory infections in the United States are for illnesses caused by viruses rather than bacteria. Antibiotics won’t help the patient get better, and are unnecessary.

The study is part of a critical national conversation seeking to find evidence-based interventions that lower health care costs and unnecessary use of health care. “Most quality improvement efforts have used audits or payfor- 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, 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,” he said.

The researchers, including lead author Daniella Meeker of RAND Corporation and Merkin Fellow at the USC Schaeffer Center, estimate that their simple intervention — a prominently displayed commitment letter — could eliminate 2.6 million unnecessary antibiotic prescriptions across the United Staes, with a saving of $70.4 million in drug costs alone. The Study To test the impact of public commitment on health behavior, the researchers had physicians post a large letter about inappropriate antibiotic prescriptions 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 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 prescriptions 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. 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.

Last Updated on Thursday, 30 January 2014 17:38