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Targeting prescriber behavior improves appropriate antimicrobial usage
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Antimicrobial stewardship interventions that incorporate behavioral theory increased the effectiveness and appropriateness of antimicrobial prescribing in hospitals, according to findings published in JAMA Internal Medicine.
“Inappropriate antimicrobial prescribing leads to antimicrobial resistance and suboptimal clinical outcomes,” Jonne J. Sikkens, MD, MSc, from the department of internal medicine at VU University Medical Center, and colleagues wrote. “Changing antimicrobial prescribing is a complex behavioral process that is not often taken into account in antimicrobial stewardship programs.”
Between Oct. 1, 2011 and Dec. 31, 2015, Sikkens and colleagues conducted the Dutch Unique Method for Antimicrobial Stewardship Participatory Intervention Study to determine whether an antibiotic stewardship approach based on behavioral theory and focused on preserving prescriber autonomy and participation effectively improved the appropriateness of antimicrobial prescribing in hospitals. The researchers measured outcomes during a baseline period of 16 months and an intervention period of 12 months. They enrolled physicians from one of seven clinical departments (two medical, three surgical and two pediatric) from two hospitals in the Netherlands that prescribed systemic antimicrobial drugs for any indication.
The researchers invited prescribers to choose and codevelop one or more interventions to enhance their own prescribing. Physicians were encouraged to choose interventions with a greater likelihood of success based on a root cause analysis of inappropriate prescribing patterns. According to Sikkens and colleagues, they based their approach on three behavioral principles: respect for the prescribers’ autonomy to avoid resistance, the inclination of individuals to value a product more if they made it themselves and the tendency of individuals to follow up on a public commitment.
Sikkens and colleagues used a validated approach based on guideline adherence and motivated guideline deviation and six repeated point prevalence surveys per year to determine and measure appropriateness of antimicrobial prescriptions. Judgement for appropriateness was masked. Data on antimicrobial consumption were extracted from pharmacy records. Outcomes over time were modeled using linear and logistic mixed-model regression analysis.
They evaluated 1,121 patient cases with 700 antimicrobial prescriptions during the baseline period and 882 patient cases with 531 antimicrobial prescriptions during the intervention period. Data indicated a significant increase of 13.3% of antimicrobial appropriateness from intervention start (64.1%) to 12-month follow-up (77.4%; RR, 1.17; 95% CI, 1.04-1.27), with no change in slope. Antimicrobial consumption did not decline.
“Use of a participatory approach based on behavioral theory with a central focus on prescriber autonomy resulted in an increase in antimicrobial appropriateness sustained for at least 12 months,” Sikkens and colleagues. “The approach is unique, inexpensive and suited to different types of hospital departments.” – by Alaina Tedesco
Disclosure: The researchers report no relevant financial disclosures.