75. Durability of Benefits of Behavioral Interventions on Inappropriate Antibiotic Prescribing in Primary Care: Follow-up from a Cluster Randomized Clinical Trial
Session: Oral Abstract Session: Antibiotic Stewardship
Thursday, October 27, 2016: 9:15 AM
Room: 288-290
Background: Antibiotics are often inappropriately prescribed for acute respiratory infections in primary care. We conducted an 18-month, 47-practice, cluster, factorial randomized trial of 3 behavioral interventions. In the intervention practices, physicians reduced their inappropriate antibiotic prescribing rates by an absolute 16% to 18%. To assess the durability of this behavior change, we measured antibiotic prescribing in the 5 months after intervention cessation.

Methods: The 3 behavioral interventions were implemented alone or in combination. Suggested alternatives presented electronic order sets suggesting non-antibiotic treatments. Accountable justification prompted clinicians to enter free-text justifications for antibiotic prescribing. Peer comparison sent monthly emails to clinicians comparing their antibiotic prescribing rate to that of “top performers.” The main comparison for this durability analysis was antibiotic prescribing for visits with antibiotic-inappropriate diagnoses (nonspecific upper respiratory tract infections, acute bronchitis, and influenza) from the 18-month intervention period to the 5-month post-intervention period, adjusting for the complex trial design.

Results: There were 16,959 antibiotic-inappropriate visits to 245 clinicians during the 18-month intervention period and 3,192 antibiotic-inappropriate visits to 224 clinicians during the 5-month post-intervention period. The adjusted antibiotic prescribing rate during the 18-month intervention period was 17% (95% confidence interval [CI], 14% to 21%) and during the 5-month post-intervention period was 15% (95% CI, 11% to 19%; p = 0.20). There were no significant changes in the adjusted antibiotic prescribing rate for each of the 3 interventions from intervention to post-intervention period: suggested alternatives, from 16% (95% CI, 11% to 21%) to 16% (95% CI, 10% to 22%; p = .09); accountable justifications, from 14% (95% CI, 11% to 18%) to 11% (95% CI, 8% to 14%; p = .25); and peer comparison, from 13% (95% CI, 8% to 17%) to 11% (95% CI, 6% to 16%; p = .99), respectively.

Conclusion: In short-term follow-up, the benefits of successful behavioral interventions to reduce inappropriate antibiotic prescribing were durable.

Jeffrey Linder, MD, MPH1, Daniella Meeker, PhD2, Craig Fox, PhD3, Mark Friedberg, MD, MPP4, Stephen Persell, MD, MPH5, Noah Goldstein, PhD3, Tara Knight, PhD2, Joel Hay, PhD2 and Jason Doctor, PhD2, (1)Brigham & Women's Hospital/Harvard Medical School, Boston, MA, (2)University of Southern California, Los Angeles, CA, (3)University of California, Los Angeles, Los Angeles, CA, (4)RAND, Boston, MA, (5)Northwestern University, Chicago, IL


J. Linder, None

D. Meeker, None

C. Fox, None

M. Friedberg, None

S. Persell, None

N. Goldstein, None

T. Knight, None

J. Hay, None

J. Doctor, None

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