Nudging Guideline-concordant Antibiotic Prescribing Using Public Commitments
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Acute Respiratory Infections (ARIs)
- Sponsor
- University of Southern California
- Enrollment
- 14
- Locations
- 1
- Primary Endpoint
- Inappropriate Antibiotic Prescribing for Patients With Acute Respiratory Infections (ARI)
- Status
- Completed
- Last Updated
- 8 years ago
Overview
Brief Summary
Inappropriate antibiotic prescribing for acute respiratory infections (ARIs) persists despite decades of intervention efforts. Negative outcomes of inappropriate antibiotics include increased costs of care, adverse drug reactions, and rising prevalence of antibiotic-resistant bacteria. To address this public health problem, we apply the principles of commitment and consistency in an effort to influence clinician decision-making through the implementation of a low-cost behavioral "nudge" in the form of a simple public commitment device. Clinicians were asked to post in their exam room a signed letter indicating their commitments to reducing inappropriate antibiotic use for ARIs. Our hypothesis is that clinicians displaying the poster-sized commitment letters will decrease their inappropriate antibiotic prescribing for ARIs as compared to clinicians in the control condition (with no posted letter).
Investigators
Jason Doctor
Associate Professor
University of Southern California
Eligibility Criteria
Inclusion Criteria
- •Medical professionals licensed to provide care and prescribe medications (including antibiotics)
- •Treating adult patients (18 years of age and older) from 5 Los Angeles community clinics
Exclusion Criteria
- Not provided
Outcomes
Primary Outcomes
Inappropriate Antibiotic Prescribing for Patients With Acute Respiratory Infections (ARI)
Time Frame: up to 12 months post intervention
Using data from electronic health records, we will calculate clinician antibiotic prescribing rates for antibiotic-inappropriate ARI diagnoses: acute nasopharyngitis (ICD-9 460.x), acute laryngitis without obstruction (465.8), acute laryngopharyngitis (465.0), acute bronchitis (466.x), acute upper respiratory infections of other multiple sites (465.8), acute upper respiratory infections not otherwise specified (465.9), bronchitis not specified as acute or chronic (490.x), non-streptococcal pharyngitis (462.xx), and influenza with other respiratory manifestations (487.1). To control for temporal trends in antibiotic prescribing and provider-fixed effects, we will fit a logistic mixed effects model that predicts inappropriate antibiotic prescribing as a function of study arm and an indicator for baseline versus intervention period (a difference-in-differences regression).