Behavioral interventions to reduce inappropriate antibiotic prescribing: a randomized pilot trial.
Behavioral interventions to reduce inappropriate antibiotic prescribing: a randomized pilot trial.
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DOI：
10.1186/s12879-016-1715-8
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发表时间：
2016-08-05
影响因子：
3.7
通讯作者：
Linder JA
中科院分区：
文献类型：
--
作者：
Persell SD;Doctor JN;Friedberg MW;Meeker D;Friesema E;Cooper A;Haryani A;Gregory DL;Fox CR;Goldstein NJ;Linder JA
临床医生经常不适当地为急性呼吸道感染（阿里斯）开抗生素。我们的目的是在一项随机对照的初步试验中测试信息技术支持的行为干预措施，以减少阿里斯的不适当抗生素处方。初级保健临床医生在2 × 2 × 2析因实验中随机分组，有3种干预措施：1）可解释的理由; 2）建议的替代方案; 3）同行比较。随后，参与者完成了一个教育模块。措施包括：抗生素处方率：不适合抗生素的ARI诊断、急性鼻窦炎/咽喉炎、呼吸道感染的所有其他诊断/症状以及所有三种ARI类别的合并。我们检查了干预前一年的3，276次访问和干预年的3，099次访问。非抗生素适用的阿里斯的抗生素处方率下降（干预前一年为24.7%，干预年为5.2%）;鼻窦炎/咽炎（50.3%至44.7%）;所有其他呼吸道感染诊断/症状（40.2%至25.3%）;以及所有类别合并（38.7%至24.2%;所有p < 0.001）。任何干预措施与非抗生素适当ARI诊断或鼻窦炎/咽炎的抗生素处方之间均无显著关系。建议的替代方案与其他诊断或呼吸道感染症状的抗生素处方减少（比值比[OR]，0.62; 95%置信区间[CI]，0.44-0.89）和所有ARI类别合并（OR，0.72; 95% CI，0.54-0.96）相关。同行比较与所有ARI类别合并的处方减少相关（OR，0.73; 95%CI，0.53-0.995）。我们观察到，无论研究参与者是否接受干预，抗生素处方都大幅减少，这表明存在压倒性的霍桑效应或可能是临床医生对临床医生的污染。低基线不适当处方可能导致下限效应。ClinicalTrials.gov：NCT01454960。本文的在线版本（doi：10.1186/s12879-016-1715-8）包含补充材料，可供授权用户使用。
Clinicians frequently prescribe antibiotics inappropriately for acute respiratory infections (ARIs). Our objective was to test information technology-enabled behavioral interventions to reduce inappropriate antibiotic prescribing for ARIs in a randomized controlled pilot test trial. Primary care clinicians were randomized in a 2 × 2 × 2 factorial experiment with 3 interventions: 1) Accountable Justifications; 2) Suggested Alternatives; and 3) Peer Comparison. Beforehand, participants completed an educational module. Measures included: rates of antibiotic prescribing for: non-antibiotic-appropriate ARI diagnoses, acute sinusitis/pharyngitis, all other diagnoses/symptoms of respiratory infection, and all three ARI categories combined. We examined 3,276 visits in the pre-intervention year and 3,099 in the intervention year. The antibiotic prescribing rate fell for non-antibiotic-appropriate ARIs (24.7 % in the pre-intervention year to 5.2 % in the intervention year); sinusitis/pharyngitis (50.3 to 44.7 %); all other diagnoses/symptoms of respiratory infection (40.2 to 25.3 %); and all categories combined (38.7 to 24.2 %; all p < 0.001). There were no significant relationships between any intervention and antibiotic prescribing for non-antibiotic-appropriate ARI diagnoses or sinusitis/pharyngitis. Suggested Alternatives was associated with reduced antibiotic prescribing for other diagnoses or symptoms of respiratory infection (odds ratio [OR], 0.62; 95 % confidence interval [CI], 0.44–0.89) and for all ARI categories combined (OR, 0.72; 95 % CI, 0.54–0.96). Peer Comparison was associated with reduced prescribing for all ARI categories combined (OR, 0.73; 95 % CI, 0.53–0.995). We observed large reductions in antibiotic prescribing regardless of whether or not study participants received an intervention, suggesting an overriding Hawthorne effect or possibly clinician-to-clinician contamination. Low baseline inappropriate prescribing may have led to floor effects. ClinicalTrials.gov: NCT01454960. The online version of this article (doi:10.1186/s12879-016-1715-8) contains supplementary material, which is available to authorized users.