Nudging Guideline-concordant Antibiotic Prescribing Using Public Commitments

University of Southern California

Status: Completed

Conditions: Acute Respiratory Infections (ARIs)

Treatments: Other: Posted commitment letter

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT01767064

USCalifornia

RC4AG039115 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

Inappropriate antibiotic prescribing for acute respiratory infections (ARIs) persists despite decades of intervention efforts. Negative outcomes of inappropriate antibiotics include increased costs of care, adverse drug reactions, and rising prevalence of antibiotic-resistant bacteria. To address this public health problem, we apply the principles of commitment and consistency in an effort to influence clinician decision-making through the implementation of a low-cost behavioral "nudge" in the form of a simple public commitment device. Clinicians were asked to post in their exam room a signed letter indicating their commitments to reducing inappropriate antibiotic use for ARIs. Our hypothesis is that clinicians displaying the poster-sized commitment letters will decrease their inappropriate antibiotic prescribing for ARIs as compared to clinicians in the control condition (with no posted letter).

Enrollment: 14 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Medical professionals licensed to provide care and prescribe medications (including antibiotics)
• Treating adult patients (18 years of age and older) from 5 Los Angeles community clinics

Exclusion criteria

• none

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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14 participants in 2 patient groups

Posted commitment letter

Experimental group

Description:

The poster-sized (18x24 inches) commitment letter, written at the 8th grade reading-level and displayed in English and Spanish, emphasize clinician commitment to guidelines for appropriate antibiotic prescribing and explain why antibiotics are not appropriate in many cases. These letters, featuring clinician photographs and signatures, are displayed in clinician exam rooms for a 16-week period.

Treatment:

Other: Posted commitment letter

Control

No Intervention group

Description:

Usual care with no posted letters.