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For many common infections, clear guidelines exist for when antibiotics should be used and when they should not. For example, antibiotics cannot cure viral illnesses like the flu or the common cold, so there is no benefit to taking them for these conditions. Further, unnecessary use of antibiotics puts patients at risk for avoidable adverse effects. And yet, inappropriate antibiotic prescribing continues to be prevalent in the U.S.
Recent research from the Centers for Disease Control and Prevention and The Pew Charitable Trusts shows that nearly 1 in 3 antibiotics prescribed at outpatient facilities—including physician’s offices, emergency departments, and hospital-based outpatient clinics—is unnecessary, amounting to 47 million prescriptions a year.
So why is there so much inappropriate prescribing of these lifesaving drugs? Many factors drive this unnecessary use, including:
Understanding the underlying behavioral drivers that contribute to inappropriate antibiotic prescribing can help guide the development of effective antibiotic stewardship. And some researchers have already started integrating behavioral science techniques into stewardship strategies, with some encouraging findings.
For example, one study showed that physicians whose offices displayed a “commitment poster” explaining their pledge to follow guidelines for appropriate antibiotic prescribing and the reasons why the drugs are not always needed, had a 20 percent lower rate of inappropriate prescribing than those not displaying a poster. Other studies using interventions that target behavioral drivers have also shown promise. One required that doctors provide a justification in the patient chart when antibiotics were prescribed for conditions for which antibiotics are not indicated, and another ranked physicians based on their level of inappropriate prescribing (i.e., those with higher rates of inappropriate prescribing were told they were “not a top performer”). Both led to significant reductions in inappropriate prescribing compared with conventional approaches.
Deciding whether or not to prescribe an antibiotic can be a complex process, during which physicians are influenced not only by medical information, but also by their interactions with patients, the uncertainties that surround medical decision-making, and the organizational challenges of delivering care in busy outpatient settings. By understanding the factors that affect physicians’ antibiotic prescribing decisions and applying concepts from the social and behavioral sciences, inappropriate prescribing can be reduced—which in turn can reduce the threat of resistance.
David Hyun, M.D., works on The Pew Charitable Trusts’ antibiotic resistance project.
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