Behavioral Interventions Reduce Inappropriate Antibiotic Prescribing for Acute Respiratory Tract Infections


Am Fam Physician. 2016 Jun 15;93(12):1037.

Clinical Question

Do behavioral interventions reduce rates of inappropriate antibiotic prescribing for acute respiratory tract infections in primary care?

Bottom Line

Requiring clinicians to justify antibiotic prescribing in the permanent electronic health record and to undergo periodic peer comparisons of prescribing rates are effective interventions for reducing inappropriate antibiotic prescribing for acute respiratory tract infections. Helpful reminders and suggested treatment alternatives do not reduce inappropriate prescribing rates. Information alone rarely changes behavior, but the desire to conform with our peers can be very persuasive. (Level of Evidence = 1b−)


Clinical guidelines encourage avoiding antibiotics for infections when treatment is of minimal, if any, benefit. However, inappropriate antibiotic prescribing for acute respiratory tract infections persists. These investigators invited 49 practices in Massachusetts and California (N = 243 clinicians) to receive various combinations of behavioral interventions aimed at reducing inappropriate antibiotic prescribing. The first intervention used automated alternative treatment suggestions when clinicians attempted to prescribe antibiotics for antibiotic-inappropriate diagnoses. A second intervention required clinicians to enter an antibiotic justification note that became a permanent part of the medical record. The third intervention distributed periodic e-mails to participating clinicians labeling them as either a “top performer” or “not a top performer” by comparing their antibiotic prescribing behavior with that of their peers.

Clinicians included internists (60%), nurse practitioners/physician assistants (19%), and family physicians (13%). The study excluded patients with chronic medical conditions that necessitate more frequent antibiotic prescriptions for acute respiratory tract infections (e.g., emphysema). Practices were randomized to receive zero, one, two, or all three interventions

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP,search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.



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Jun 15, 2017

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