Reminders Can Reduce Inappropriate Prescriptions

A new study by The Children's Hospital of Philadelphia researchers has found that reminding clinicians of prescription guidelines, as well as providing them with feedback about their own habits, can significantly improve antibiotic prescribing.

Jeffrey Gerber, MD, PhD, an assistant professor of Pediatrics in the Division of Infectious Diseases, presented his study of antibiotic prescribing practices at the IDWeek conference, which was held recenly in San Diego, Ca. The study — of which Dr. Gerber was co-principal investigator, along with Theoklis Zaoutis, MD, MSCE, associate director of the Center for Pediatric Clinical Effectiveness Research — examined the prescribing habits of clinicians from across CHOP's network of urban, suburban, and rural primary care practices.

Roughly half of antibiotics are prescribed unnecessarily, Dr. Gerber noted. Overuse of antibiotics can lead to a number of negative outcomes, including an increase in healthcare costs, adverse events such as diarrhea, and bacterial resistance.

The study was conducted over 32 months, a period comprising approximately 1.4 million visits by more than 185,000 patients. The researchers split the 140 clinicians who took part in the study into two groups, a control arm and an intervention arm. While the control group was only told of the study's existence, each practice in the intervention group received a one-hour in office presentation of Infectious Diseases Society of America and American Academy of Pediatrics prescription guidelines followed by periodic updates on their prescribing practices relative to these guidelines.

The researchers found that, before any of the interventions, roughly 28 percent of patients were prescribed off-guideline antibiotics. However, after either informing clinicians that they were being studied or actively intervening, the researchers saw that number decrease. Those clinicians who received the regular updates and the refresher cut their off-guideline prescriptions to 14 percent, while the control group's number went down to 23 percent.

The impact on the intervention group "shows that getting people up to speed and providing simple reminders are helpful," Dr. Gerber said.

Going forward, Dr. Gerber and his colleagues plan to continue collecting data to determine whether the reduction in off-label prescriptions is sustainable. The researchers will also gather feedback from physicians "to see what's driving antibiotic prescribing," Dr. Gerber noted.