Greater 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.
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.
- Improving antibiotic use. (2015, June 2). Retrieved from http://www.cdc.gov/features/antibioticuse/
- 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
- 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/
- 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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