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Reducing Inappropriate Antibiotic Rx

Posting a letter in exam rooms about the fact that antibiotic prescriptions for cold symptoms are not only useless but contribute to the problem of antibiotic-resistant bacterialowered the incidence of unnecessary prescriptions by nearly 20 percent, saving a whopping  $70 million a year in drug costs. That is the finding of research done at the University of Southern California, the RAND Corporation, Brigham and Women's Hospital, and Harvard.The study was published in JAMA Internal Medicineon January 27th 2014.

A release from the university reports that inappropriate antibiotic prescriptions are a major public health concern. Still, despite widely accepted prescription guidelines, physicians continue to prescribe antibiotics for colds even when they won't help. In the United States, nearly half the antibiotic prescriptions given for respiratory infections are inappropriate. For illnesses caused by viruses rather than bacteria, antibiotics won't help the patient get better. The study is part of a critical national conversation led by researchers at the USC Schaeffer Center for Health Policy and Economics to find evidence-based interventions that lower health care costs and unnecessary use of health care.

The release quotes senior author Jason Doctor as saying, "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. 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."

To test the impact of public commitment on health behavior, the researchers had physicians post a large letter about inappropriate antibiotic prescription in their exam rooms. The letter, displayed in both English and Spanish in Los Angeles clinics, had a picture of the physician and his or her signature, and explained the physician's commitment to reducing inappropriate prescriptions for acute respiratory infections such as the common cold.

The researchers then looked at clinic records over the next three months, comparing rates of inappropriate antibiotic prescriptions to a control group that did not sign or post a public commitment poster. A signed commitment poster dramatically decreased unnecessary antibiotic prescriptions: among physicians who posted the letter, inappropriate antibiotic prescriptions fell nearly 10 percentage points, to 33.7 percent of total antibiotic prescriptions from 42.8 percent in the year before the study.