Pediatricians leery of antibiotic prescribing audit data

WASHINGTON — Primary care pediatricians report skepticism of antibiotic prescribing audit data, according to study results presented at the 2013 Pediatric Academic Societies Annual Meeting.

“Plans to disseminate a similar intervention on a broader scale should include efforts to boost the credibility of audit data to increase the acceptability of the intervention and avoid potential ‘gaming’ behavior,” wrote study researcher Julia E. Szymczak, MA, PhD candidate in the department of sociology at the University of Pennsylvania.

The cluster-randomized trial evaluated interviews from 21 physicians at five clinics in a large pediatric primary care network to improve antibiotic prescribing for common acute respiratory tract infections. The study included an education session and quarterly feedback reports for 1 year of individual prescribing that were audited to encourage behavior change.

Researchers found that six participants reported they ignored or did not remember receiving audit reports. Of the 15 who reported receiving them, nine said they did not believe the reports and were skeptical of the data.

According to researchers, participants who reported skepticism said their reasons included: uncertainty of the origin of data, belief that patient encounters could have been improperly documented, and belief that the audit did not capture the complexity of a patient’s case. One participant reported working around the audit by adding bacterial diagnoses to patient cases for acute respiratory infections, despite absence of a bacterial infection, to avoid a feedback report of poor performance.

Jeffrey S. Gerber

“This study suggests that interventions intending to change provider prescribing via audit and feedback should include efforts to boost the credibility of the reports to increase the acceptability of the intervention and avoid gaming behavior,” study researcher Jeffrey S. Gerber, MD, PhD, assistant professor of pediatrics at the University of Pennsylvania School of Medicine, told Infectious Diseases in Children.

For more information:

Szymczak JE. #2913.159. Presented at: Pediatric Academic Societies Annual Meeting; May 4-7, 2013; Washington.

Disclosure: The researchers report no relevant financial disclosures.