Study examines effects of removing behavioral interventions on inappropriate antibiotic prescribing

In the 12 months after removing behavioral interventions, inappropriate antibiotic prescribing for acute respiratory infections increased relative to control practices, according to a study published by JAMA.

Inappropriate antibiotic prescribing contributes to antibiotic resistance and leads to adverse events. A randomized trial of three behavioral interventions intended to reduce inappropriate prescribing found that 2 of the 3 interventions were effective. Jason N. Doctor, Ph.D., of the University of Southern California, Los Angeles, examined the persistence of effects 12 months after stopping the interventions. The researchers randomized 47 primary care practices in Boston and Los Angeles and enrolled 248 clinicians to receive 0, 1, 2, or 3 interventions for 18 months. All clinicians received education on antibiotic prescribing guidelines.

The authors found that during the postintervention period, the rate of inappropriate antibiotic prescribing decreased in control clinics from 14.2 percent to 11.8 percent, and for the different types of interventions, it increased from 7.4 percent to 8.8 percent for suggested alternatives; increased from 6.1 percent to 10.2 percent for accountable justification; and increased from 4.8 percent to 6.3 percent for peer comparison. During the postintervention period, peer comparison remained lower than control, whereas accountable justification was not different from control.

Limitations of the study are that it only included volunteering clinicians from selected practices, and the postintervention follow-up was only 12 months.

"These findings suggest that institutions exploring behavioral interventions to influence clinician decision-making should consider applying them long-term," the authors write.​