October 26, 2017

Want to change prescribing behavior? Use peer pressure, study finds

Daily Briefing

    Making doctors aware of how frequently they prescribe antibiotics compared with their peers might be the most effective way to prevent unnecessary antibiotic prescriptions in the long term, according to a study published in JAMA.

    According to Modern Healthcare, the study is a follow-up to research published last year that assessed how three different interventions affected antibiotic prescribing habits of 248 primary care providers at 47 practices in Boston and Los Angeles over an 18-month period. The three interventions included:

    • Monthly emails to providers showing the rate of inappropriate antibiotic prescribing in comparison with other physicians;
    • Requirements that physicians explain why they prescribed antibiotics; and
    • EHR notifications that suggested non-antibiotic alternatives to providers.

    The researchers found the interventions that had the largest effect on inappropriate antibiotic prescriptions were the explanation requirements and the peer-comparison emails.

    For the new study, the interventions were stopped, and the researchers monitored the doctors' inappropriate antibiotic prescribing rates for 12 months to see if without the interventions, they would rise again. They found that while the rate of inappropriate antibiotic prescribing increased among all the intervention groups, it remained lowest—at 6.3 percent—among the group of doctors that had been compared with their peers.

    Discussion

    Jason Doctor, co-author of the study and the chair of the health policy and management department at the University of Southern California-Los Angeles, said people tend to think doctors, as experts, are not affected by the sort of factors that affect laypeople, such as peer pressure and the desire to fit in with others. "It creates a tension in our mind because we think of doctors as experts," Doctor said. "But there is a difference between being an expert in understanding clinical facts and understanding how to make the best decisions."

    Separately, Jeffrey Linder, co-author of the study and the chief of the general internal medicine and geriatrics division at Northwestern University's Feinberg School of Medicine, said the findings indicate hospital systems should consider implementing similar interventions on a long-term basis. "Doctors are people too and we want to be liked by people, and we want to do well relative to our colleagues," he said. "Why shouldn't doctors respond to the same sort of peer comparisons and social norms that everyone does?" (Ross Johnson, Modern Healthcare, 10/13; Finnegan, FierceHealthcare, 10/17).

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