Behavioral Economics Interventions to Reduce Antibiotic Overprescribing
Antibiotic resistance leads to more than 94,000 life-threatening infections and 18,500 deaths annually in the U.S. Acute respiratory infections (ARIs) are the most common reason for inappropriate antibiotic use. Interventions that apply behavioral economic principles may be more effective and cost effective than standard approaches (e.g., provider education, pay for performance, etc.) in deterring inappropriate ARI antibiotic prescribing by well-informed clinicians. In three different studies, including a stated preference discrete choice experiment (DCE), a large national multi-site RCT of prescriber interventions, and a randomized trial of prescriber public commitment pledges, we evaluated the effectiveness of alternative behavioral economics approaches to reducing antibiotic overprescribing. Three multi-site RCT interventions in Los Angeles, Chicago and Boston included; i) default computerized prescription order entry (CPOE) screen with non-antibiotic suggested alternative (SA) prescriptions, ii) accountable justification (AJ) CPOE screen requiring the prescriber to write brief medical justifications for ARI antibiotic orders, and iii) a peer comparison (PC) intervention where the prescribers received regular periodic communications matching their own rate of ARI antibiotic prescribing with that of the top 10% of their peers. The DCE compares clinician preferences for the three CPOE RCT interventions against financial pay-for-performance and educational incentives for primary care providers. This session will contrast the stated preferences of physicians in the DCE against the physician revealed preferences and the outcomes demonstrated in the two provider RCTs. This multiple design study is a unique opportunity to validate what providers say is effective against what actually works in real world behavioral economics interventions.