1896. Categorical risk perception drives variability in clinician antibiotic prescribing in the acute-care setting
Session: Poster Abstract Session: Antibiotic Stewardship: Outpatient and ED
Saturday, October 29, 2016
Room: Poster Hall
Background: Inappropriate antibiotic prescribing, particularly for upper respiratory infections (URIs), is a major driver of antibiotic resistance. Despite clear, evidence-based guidelines for treating upper respiratory illness, there is significant variability in prescribing rates by physician. A lack of clarity regarding the drivers of prescribing variability hampers the effectiveness of interventions to reduce inappropriate prescribing. To advance understanding of the drivers of variability in antibiotic prescribing, we applied fuzzy-trace theory, a theory of medical decision making that helps explain how judgments are formed based on the categorical meanings or gists that individuals derive from information.

Methods: Retrospective prescribing decisions for emergency department patients with a URI diagnosis over a 17-month time period were combined with survey data on categorical gists that underlie clinician prescribing decisions in a multivariate regression model.

Results: Antibiotic prescribing was highly variable (figure). A total of 94 clinicians completed the survey (61% completion rate). The categorical gists relating to side-effects and risk-taking captured the majority (66%) of variance in the survey results, while satisfying patients was not regarded as significant. Analysis >4,000 patient URI encounters found that variability in antibiotic prescribing rate was most significantly explained by categorical gists of the prescribers. In particular, greater agreement with statements capturing the “why not take a risk” categorical gist had increased rates of prescribing. Those who did not agree with the gist relating to side effects also had higher prescribing rates.

Conclusion: Our results provide evidence that clinicians’ prescribing decisions are not principally motivated by a desire to satisfy patients, but by a strategic bias assuming that the possibility of effective treatment trumps risk of antibiotic-associated side effects. Greater regard for the significance of side effects ameliorates this bias. Interventions that emphasize the non-negligible possibility of serious side-effects of antibiotic use may thus be more effective than current approaches using education to reduce inappropriate prescribing.

Eili Klein, PhD, Center for Disease Dynamics, Economics & Policy, Washington, DC; Emergency Medicine, Johns Hopkins University, Baltimore, MD, Elena Martinez, MS, MPH, Center for Disease Dynamics, Economics, and Policy, Washington, DC, Larissa May, MD, MSPH, Emergency Medicine, The George Washington University, Washington, DC, Mustapha Saheed, MD, Johns Hopkins Medical Institutions, Baltimore, MD, Valerie Reyna, PhD, Cornell University, Ithaca, NY and David Broniatowski, PhD, The George Washington University, Washington, DC

Disclosures:

E. Klein, None

E. Martinez, None

L. May, None

M. Saheed, None

V. Reyna, None

D. Broniatowski, None

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