Prescriber preferences for behavioural economics interventions to improve treatment of acute respiratory infections: a discrete choice experiment.
Prescriber preferences for behavioural economics interventions to improve treatment of acute respiratory infections: a discrete choice experiment.
复制标题
DOI：
10.1136/bmjopen-2016-012739
复制
发表时间：
2016-09-22
期刊：
影响因子：
2.9
通讯作者：
Doctor JN
中科院分区：
文献类型：
--
作者：
Gong CL;Hay JW;Meeker D;Doctor JN
引出处方者对旨在减少不当抗生素处方的行为经济学干预措施的偏好，并将其与实际行为进行比较。离散选择实验（DCE）。波士顿和洛杉矶的47个初级保健中心，234个初级保健提供者，平均从业20年。一项行为经济干预试验的结果与处方者陈述的对相同干预措施的偏好进行了比较，这些干预措施与改善处方结果的金钱和时间奖励有关。在随机对照试验（RCT）部分，研究了3种计算机化处方订单输入触发的干预措施，包括：建议替代方案（SA），如果开了不适当的抗生素，则警告填充非抗生素治疗方案；可问责的理由（JA），这促使开处方者为不适当开的抗生素输入理由，然后记录在患者的病历中；以及同行比较（PC），定期向每位处方者发送电子邮件，比较他/她的抗生素处方率与那些抗生素不当处方率最低的人的抗生素处方率。使用DCE研究组件来确定开处方者是否认为SA、JA、PC、按绩效付费或额外的临床时间将最有效地减少他们不适当的抗生素处方。计算每个干预措施的支付意愿（WTP）。在RCT中，PC和JA被发现是减少不适当抗生素处方的最有效干预措施，而SA与对照组没有显著差异。然而，在DCE中，无论在RCT期间接受何种治疗干预，处方者压倒性地倾向于SA，其次是PC，然后是JA。WTP估计表明，每项干预措施的实施比每月200美元的绩效奖励要便宜得多。处方行为和陈述偏好不一致，这表明仅依靠陈述偏好来告知干预设计可能会消除有效的干预措施。NCT01454947;结果。
To elicit prescribers' preferences for behavioural economics interventions designed to reduce inappropriate antibiotic prescribing, and compare these to actual behaviour. Discrete choice experiment (DCE). 47 primary care centres in Boston and Los Angeles. 234 primary care providers, with an average 20 years of practice. Results of a behavioural economic intervention trial were compared to prescribers' stated preferences for the same interventions relative to monetary and time rewards for improved prescribing outcomes. In the randomised controlled trial (RCT) component, the 3 computerised prescription order entry-triggered interventions studied included: Suggested Alternatives (SA), an alert that populated non-antibiotic treatment options if an inappropriate antibiotic was prescribed; Accountable Justifications (JA), which prompted the prescriber to enter a justification for an inappropriately prescribed antibiotic that would then be documented in the patient's chart; and Peer Comparison (PC), an email periodically sent to each prescriber comparing his/her antibiotic prescribing rate with those who had the lowest rates of inappropriate antibiotic prescribing. A DCE study component was administered to determine whether prescribers felt SA, JA, PC, pay-for-performance or additional clinic time would most effectively reduce their inappropriate antibiotic prescribing. Willingness-to-pay (WTP) was calculated for each intervention. In the RCT, PC and JA were found to be the most effective interventions to reduce inappropriate antibiotic prescribing, whereas SA was not significantly different from controls. In the DCE however, regardless of treatment intervention received during the RCT, prescribers overwhelmingly preferred SA, followed by PC, then JA. WTP estimates indicated that each intervention would be significantly cheaper to implement than pay-for-performance incentives of $200/month. Prescribing behaviour and stated preferences are not concordant, suggesting that relying on stated preferences alone to inform intervention design may eliminate effective interventions. NCT01454947; Results.
登录
查看更多内容
影响因子：
120.7
作者：
Grijalva, Carlos G.;Nuorti, J. Pekka;Griffin, Marie R.
通讯作者：
Griffin, Marie R.
影响因子：
4.4
作者：
Linley, Warren G.;Hughes, Dyfrig A.
通讯作者：
Hughes, Dyfrig A.
影响因子：
3.7
作者：
Persell SD;Friedberg MW;Meeker D;Linder JA;Fox CR;Goldstein NJ;Shah PD;Knight TK;Doctor JN
通讯作者：
Doctor JN
影响因子：
3.3
作者：
Frolich, Anne;Talavera, Jason A.;Dudley, R. Adams
通讯作者：
Dudley, R. Adams
影响因子：
105.7
作者：
Kawamoto, K;Houlihan, CA;Lobach, DF
通讯作者：
Lobach, DF