Health care savings: Reducing inappropriate antibiotic prescriptions

January 27, 2014, University of Southern California

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 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 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 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.

Explore further: Inappropriate antibiotic use in emergency rooms not decreasing in adults

Related Stories

Inappropriate antibiotic use in emergency rooms not decreasing in adults

January 9, 2014
An analysis of emergency room (ER)visits over a 10-year period finds that while inappropriate antibiotic use is decreasing in pediatric settings, it continues to remain a problem in adults, according to an article published ...

Targeting prescribers can reduce excessive use of antibiotics in hospitals

April 29, 2013
Giving prescribers access to education and advice or imposing restrictions on use can curb overuse or inappropriate use of antibiotics in hospitals, according to a new Cochrane systematic review. This is important because ...

Antibiotics often the wrong prescription for pediatric asthma

June 1, 2011
(Medical Xpress) -- At nearly one in six pediatric asthma visits, antibiotics are prescribed as a remedy, despite national guidelines against the practice. Ian Paul, departments of pediatrics and public health sciences, Penn ...

Study examines role of seasonal prescribing changes in antibiotic resistance

July 2, 2012
A new study published in Clinical Infectious Diseases and available online shows how seasonal changes in outpatient antibiotic use – retail sales of antibiotics typically get a boost during the winter – can significantly ...

New strategy could reduce inappropriate use of antibiotics

September 10, 2013
Researchers have developed a new strategy for prescribing antibiotics that could reduce patient harm and help combat the rise in antibiotic resistance.

CDC addresses burden, threat of antibiotic resistance

January 6, 2014
(HealthDay)—The burden and threats posed by antibiotic resistance infections are discussed in a report published by the U.S. Centers for Disease Control and Prevention.

Recommended for you

In most surgery patients, length of opioid prescription, number of refills spell highest risk for misuse

January 17, 2018
The possible link between physicians' opioid prescription patterns and subsequent abuse has occupied the attention of a nation in the throes of an opioid crisis looking for ways to stem what experts have dubbed an epidemic. ...

Patients receive most opioids at the doctor's office, not the ER

January 16, 2018
Around the country, state legislatures and hospitals have tightened emergency room prescribing guidelines for opioids to curb the addiction epidemic, but a new USC study shows that approach diverts attention from the main ...

FDA bans use of opioid-containing cough meds by kids

January 12, 2018
(HealthDay)—Trying to put a dent in the ongoing opioid addiction crisis, the U.S. Food and Drug Administration on Thursday slapped strict new restrictions on the use of opioid-containing cold and cough products by kids.

Taking ibuprofen for long periods found to alter human testicular physiology

January 9, 2018
A team of researchers from Denmark and France has found that taking regular doses of the pain reliever ibuprofen over a long period of time can lead to a disorder in men called compensated hypogonadism. In their paper published ...

Nearly one-third of Canadians have used opioids: study

January 9, 2018
Nearly one in three Canadians (29 percent) have used "some form of opioids" in the past five years, according to data released Tuesday as widespread fentanyl overdoses continue to kill.

Growing opioid epidemic forcing more children into foster care

January 8, 2018
The opioid epidemic has become so severe it's considered a national public health emergency. Addiction to prescription painkillers, such as oxycodone and morphine, has contributed to a dramatic rise in overdose deaths and ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.