Nudge Helps Practices with Antibiotics

A new study finds programs that appeal to the competitive spirit of physicians are effective in getting them to reduce their incidence of prescribing unnecessary antibiotics.

The study from researchers at the USC Schaeffer Center for Health Policy and Economics was published in the February issue of the Journal of the American Medical Association. In it, researchers tested the effectiveness of behavioral interventions called nudges to curtail the inappropriate prescribing of antibiotics for respiratory infections at 49 medical practices in Boston and Los Angeles. Nudges are prompts designed to change behaviors by assessing penalties for noncompliance.

“Until now, most efforts to reduce antibiotic prescribing have involved education, reminders, or giving financial incentives to physicians,” says senior study author Jason Doctor, director of health informatics at the USC Schaeffer Center for Health Policy and Economics. “We decided to test if socially motivated interventions, such as instilling pride in their performance or making physicians accountable for their directions, would help address the problem. Our findings here suggest that they may.”

The study followed 248 clinicians for 18 months. It found that two of the three nudges used in the study collectively prevented an inappropriate antibiotic prescription for one of every eight patients treated. During that time, clinicians treated 16,959 patients for respiratory infections.

The most successful intervention used in the study was accountable justification. The nudge was a prompt that would appear in a patient’s EHR asking a clinician to explain and justify why a prescription was being written for a respiratory infection. The written justification was added as a note in the patient’s EHR accompanying the prescription. The study found that accountable justification resulted in an 18% reduction in prescriptions written for respiratory infections.

This article was originally published in  the July 2016 issue of  Physician Practice Perspectives.