Public Accountability Could Prevent Overprescription

Sick woman sleeping next to medicinesGreater accountability, comparisons to peers, and requiring doctors to justify their use of antibiotics could cut back on overuse of these drugs, according to a new study published in JAMA.

The United States Centers for Disease Control (CDC) estimates between a third and a half of all antibiotic prescriptions are unnecessary. Overuse of antibiotics can increase antibiotic resistance, and the practice can also expose patients to antibiotic side effects.

A variety of public health campaigns have failed to stop unnecessary antibiotic prescriptions. The study’s authors suggest part of the problem might be the presumption that doctors behave in completely rational ways based on available evidence. Instead, they may respond to a range of scientific and emotional cues, making them vulnerable to public pressure and comparisons to their peers.

Reducing Antibiotic Overuse through Public Pressure

Researchers developed three specific interventions to reduce overuse of prescription antibiotics. One method suggested alternatives to antibiotics to doctors who submitted their antibiotic prescriptions to an electronic device. A second required doctors to provide justifications for their use of antibiotics by entering the justification into a patient’s medical record. A final approach directly compared doctors to their peers by sending emails to doctors comparing them to “top performers”—clinicians with the lowest antibiotic prescription rates.

The team tested the interventions in 47 primary care clinics in Boston and Los Angeles, including 248 clinicians in the group of participants. Each doctor received guidelines about appropriate antibiotic use before participating in the study. Study enrollment dates varied, with each clinic tracked for a minimum of 18 months. During the study period, the participants saw a total of 14,753 people with respiratory symptoms for which antibiotic treatment would be inappropriate.

All three accountability-oriented approaches reduced physicians’ overuse of prescription antibiotics:

  • The control group, which received no accountability-oriented interventions, had an overprescription rate of 24.1% at the study’s beginning, and a reduced rate of 13.1% at its conclusion.
  • The group that received a list of alternatives to antibiotics had an overuse rate of 22.1% that dropped to 6.1%.
  • Physicians required to justify their antibiotic prescriptions experienced a drop from 23.2% to 5.2%.
  • Doctors who received emails comparing them to their peers saw a decrease from 19.9% to 3.7%.

Implications for Other Drug Crises

Although this study only looked at physicians’ role in prescribing antibiotics, it presents data that could be used to reduce other prescription drug crises. In 2012, doctors wrote 259 million opioid painkiller prescriptions. According to the CDC, this overuse of prescription opioids has spurred an opioid addiction and overdose epidemic. If accountability measures help doctors make better decisions with antibiotic prescriptions, those same measures might also work to reduce excessive use of other drugs, particularly opioids.

References:

  1. Improving antibiotic use. (2015, June 2). Retrieved from http://www.cdc.gov/features/antibioticuse/
  2. Meeker, D., Linder, J. A., Fox, C. R., Friedberg, M. W., Persell, S. D., Goldstein, N. J., . . . Doctor, J. N. (2016). Effect of behavioral interventions on inappropriate antibiotic prescribing among primary care practices. JAMA,315(6), 562. doi:10.1001/jama.2016.0275
  3. Mole, B. (2016, March 28). Best way to stop overprescribing antibiotics? Public shaming, of course. Retrieved from http://arstechnica.com/science/2016/03/best-way-to-stop-overprescribing-antibiotics-public-shaming-of-course/
  4. Opioid painkiller prescribing varies widely among states. (2014, July 1). Retrieved from http://www.cdc.gov/media/releases/2014/p0701-opioid-painkiller.html

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  • R Johnson

    R Johnson

    April 1st, 2016 at 3:28 PM

    This study clearly shows that accountability can be used as a means to reduce the rate of physicians overusing prescription drugs. It is reasonable to translate these results of over-prescribed antibiotics to opiates that are over-prescribed for the treatment of pain.

  • darrell

    darrell

    April 2nd, 2016 at 11:58 AM

    But you know that there are those people who go to the doctor and they practically demand that they receive an antibiotic. They for some reason have come to believe that a drug is the only thing that can heal them, even when many times it takes just a little bit of time to wait it out.

  • Franklin G

    Franklin G

    April 4th, 2016 at 10:49 AM

    Now how many normal people out there are going to question those in a power position and who are medically trained doctors? I would feel ridiculous doing that.

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