With populations of antibiotic-resistant bacteria growing constantly, and the development of new antibiotics lagging, researchers have begun getting creative in finding ways to reduce the amount of unnecessary antibiotic prescriptions. One such way that physicians could do this, according to a new study, is by simply hanging up a letter in their office stating their commitment.

Antibiotic resistance has been a growing and pressing issue. In September, the Centers for Disease Control and Prevention (CDC) released a report rating the threats that certain resistant bacteria presented to the public. If antibiotic use isn’t curbed in the near future, the United States and other parts of the world may see a rise in previously stifled diseases. Beyond that, the germs can come back with a vengeance, as they build resistance from exposure to antibiotics in the human body and on farms. In October, an antibiotic-resistant Salmonella outbreak from a Foster Farms chicken production plant in California led to twice the expected rate of hospitalizations.

For the study, researchers looked to a psychological “nudge” to shift doctors’ prescribing habits — rather than confrontation or frequent reminders. “Most quality improvement efforts have used audits or pay-for-performance incentives to try to change what providers do, but they ignore social influences that affect all people, including physicians,” senior author Jason Doctor, of the University of Southern California Schaeffer Center for Health Policy and Economics, said in a statement. “Our study is the first to apply the principles of commitment and consistency to prescribing behavior and finds a simple, low-cost intervention that shows great promise in reducing inappropriate antibiotic prescription.”

The “nudge” came in the form of a large commitment letter showing a photo of the physician, and explaining their promise to reduce unnecessary antibiotic prescriptions for acute respiratory infections like the common cold. The letter, which was posted in each exam room for three months, resulted in a 10 percent drop, bringing the rate of total antibiotic prescriptions down from 42.8 percent to 33.7 percent. On the other hand, antibiotic prescription rates increased in the control group from 43.5 percent to 52.7 percent.

Through a program like this, the researchers estimate that they can prevent up to 2.6 million unnecessary antibiotic prescriptions, saving $70.4 million in the U.S., and slowing the spread of antibiotic resistant bacteria. “The results move beyond education posters,” Doctor said in the statement, “showing how public commitments and active engagement can prompt greater personal motivation to perform a behavior, in this case reversing a tendency to prescribe antibiotics when they are not effective.”

 

 

Source: Meeker D, Doctor J, Knight T, et al. Nudging Guideline-Concordant Antibiotic Prescribing: A Randomized Clinical Trial. JAMA Internal Medicine. 2014.