Use of behavioral economics and social psychology to improve treatment of acute respiratory infections (BEARI): rationale and design of a cluster randomized controlled trial [1RC4AG039115-01]--study protocol and baseline practice and provider characteristics.
Use of behavioral economics and social psychology to improve treatment of acute respiratory infections (BEARI): rationale and design of a cluster randomized controlled trial [1RC4AG039115-01]--study protocol and baseline practice and provider characteristics.
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DOI：
10.1186/1471-2334-13-290
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发表时间：
2013-06-27
影响因子：
3.7
通讯作者：
Doctor JN
中科院分区：
文献类型：
--
作者：
Persell SD;Friedberg MW;Meeker D;Linder JA;Fox CR;Goldstein NJ;Shah PD;Knight TK;Doctor JN
非细菌性感染的不当抗生素处方导致护理费用增加，细菌对抗生素产生耐药性，以及药物不良事件。急性呼吸道感染（ARIs）是不适当使用抗生素的最常见原因。大多数先前减少急性呼吸道感染不适当抗生素处方的努力（例如，教育或信息干预）都依赖于一种隐含的假设，即临床医生不适当开抗生素是因为他们不知道急性呼吸道感染的指南建议。如果缺乏指南意识不是不适当开处方的原因，教育干预对开处方率的影响可能有限。相反，应用社会心理学和行为经济学原理的干预措施可能更有效地阻止信息灵通的临床医生为急性呼吸道感染开不适当的抗生素处方。行为经济学在改善急性呼吸道感染治疗中的应用（BEARI）试验是一项以实践为随机化单位的多地点、集群随机对照试验。主要目的是测试基于行为经济学原则的三种干预措施的能力，以减少急性呼吸道感染的不适当抗生素处方率。我们采用2 × 2 × 2因子设计随机化实践，对非抗生素适当诊断接受多达三种干预措施：1)可问责的理由：当为ARI开抗生素处方时，临床医生被提示在患者电子健康记录中记录明确的理由；2)建议的替代方案：通过计算机临床决策支持，为ARI开具抗生素处方的临床医生在完成抗生素处方之前会收到非抗生素治疗选择清单（包括处方选项）；3)同行比较：每个供应商相对于表现最好的同行的不适当抗生素处方率定期通过电子邮件报告给供应商。我们在49个参与的诊所招募了269名临床医生（执业主治医生或高级执业护士），并收集了基线数据。主要结果是就诊的非抗生素适宜性ARI诊断的抗生素处方率。次要结果将更广泛地检查抗生素处方。在18个月的干预期之后，将进行为期一年的随访，以衡量干预结束后效果的持久性。正在进行的BEARI试验将评估行为经济策略在减少不当抗生素处方方面的有效性。ClinicalTrials.gov: NCT01454947
Inappropriate antibiotic prescribing for nonbacterial infections leads to increases in the costs of care, antibiotic resistance among bacteria, and adverse drug events. Acute respiratory infections (ARIs) are the most common reason for inappropriate antibiotic use. Most prior efforts to decrease inappropriate antibiotic prescribing for ARIs (e.g., educational or informational interventions) have relied on the implicit assumption that clinicians inappropriately prescribe antibiotics because they are unaware of guideline recommendations for ARIs. If lack of guideline awareness is not the reason for inappropriate prescribing, educational interventions may have limited impact on prescribing rates. Instead, interventions that apply social psychological and behavioral economic principles may be more effective in deterring inappropriate antibiotic prescribing for ARIs by well-informed clinicians. The Application of Behavioral Economics to Improve the Treatment of Acute Respiratory Infections (BEARI) Trial is a multisite, cluster-randomized controlled trial with practice as the unit of randomization. The primary aim is to test the ability of three interventions based on behavioral economic principles to reduce the rate of inappropriate antibiotic prescribing for ARIs. We randomized practices in a 2 × 2 × 2 factorial design to receive up to three interventions for non-antibiotic-appropriate diagnoses: 1) Accountable Justifications: When prescribing an antibiotic for an ARI, clinicians are prompted to record an explicit justification that appears in the patient electronic health record; 2) Suggested Alternatives: Through computerized clinical decision support, clinicians prescribing an antibiotic for an ARI receive a list of non-antibiotic treatment choices (including prescription options) prior to completing the antibiotic prescription; and 3) Peer Comparison: Each provider’s rate of inappropriate antibiotic prescribing relative to top-performing peers is reported back to the provider periodically by email. We enrolled 269 clinicians (practicing attending physicians or advanced practice nurses) in 49 participating clinic sites and collected baseline data. The primary outcome is the antibiotic prescribing rate for office visits with non-antibiotic-appropriate ARI diagnoses. Secondary outcomes will examine antibiotic prescribing more broadly. The 18-month intervention period will be followed by a one year follow-up period to measure persistence of effects after interventions cease. The ongoing BEARI Trial will evaluate the effectiveness of behavioral economic strategies in reducing inappropriate prescribing of antibiotics. ClinicalTrials.gov: NCT01454947