Interventions Reduce Inappropriate Antibiotic Prescribing in Primary Care Practices

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Two behavioral interventions can help reduce inappropriate antibiotic prescriptions for acute respiratory tract infections at primary care practices, a JAMA study suggests.

Nearly 50 practices in Boston and Southern California were randomized to the following interventions (alone or in combination) for 18 months:

• Suggested alternatives: An EHR-based intervention in which acute respiratory tract infection diagnoses prompted a pop-up message stating "antibiotics are not generally indicated" and then listed treatment alternatives.

• Accountable justification: Clinicians seeking to prescribe antibiotics were prompted by their EHR to write a justification for the prescription; the justification then appeared in the patient's medical record.

• Peer comparison: Participants received monthly emails in which their rate of inappropriate prescribing was ranked against other participants' rates.

After adjustment for co-occurring interventions, accountable justification and peer comparison each led to significantly greater reductions in inappropriate antibiotic prescribing relative to no intervention. From the pre-intervention period to the intervention's end, the rate of inappropriate prescribing fell from 23% to 5% with accountable justification, and from 20% to 4% with peer comparison (vs. from 24% to 13% with control).

Dr. Thomas Schwenk of NEJM Journal Watch General Medicine commented: "The baseline rate of inappropriate prescribing was already low compared with national data and declined over the 18-month run-in period, suggesting that these results may not generalize to other physician groups. However, interventions that focus on physician professional pride and performance appear to have promise, and should be easily implemented in any practice with an EHR."