Pledges Reduce Inappropriate Antibiotic Prescribing Rates
The 12-week experiment, conducted during flu season in 2011, took place in five outpatient primary care federally qualified health centers.
During a baseline period, 14 clinicians divided into two groups prescribed antibiotics inappropriately to patients with viral infections about 43% of the time in each group. Both groups received a reminder about basic guidelines in antibiotics at the start of trial.
Then the two groups were divided. Clinicians in the intervention group signed letters of commitment that were blown up on 18" by 24" posters that also carried their photographs. The posters were hung at the patient's eye level in the exam rooms and said, in part:
Antibiotics, like penicillin, fight infections due to bacteria that can cause some serious illnesses. But these medicines can cause side effects like skin rashes, diarrhea, or yeast infections. If your symptoms are from a virus and not from bacteria, you won't get better with an antibiotic…"
The posters explain that antibiotics make bacteria more resistant, which makes future infections harder to treat, and less likely to work "when you really need them."
In the group of doctors whose office walls displayed the posters, inappropriate prescribing decreased to 33.7%. For the group of doctors whose office walls did not carry the personalized posters, inappropriate prescribing increased to 52.7%.
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