Nudging Guideline-concordant Antibiotic Prescribing Using Public Commitments
This study is ongoing, but not recruiting participants.
Sponsor:
University of Southern California
Collaborators:
Information provided by (Responsible Party):
University of Southern California
ClinicalTrials.gov Identifier:
NCT01767064
First received: January 10, 2013
Last updated: NA
Last verified: January 2013
History: No changes posted
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Purpose
Inappropriate antibiotic prescribing for acute respiratory infections (ARIs) persists despite decades of intervention efforts. Negative outcomes of inappropriate antibiotics include increased costs of care, adverse drug reactions, and rising prevalence of antibiotic-resistant bacteria. To address this public health problem, we apply the principles of commitment and consistency in an effort to influence clinician decision-making through the implementation of a low-cost behavioral "nudge" in the form of a simple public commitment device. Clinicians were asked to post in their exam room a signed letter indicating their commitments to reducing inappropriate antibiotic use for ARIs. Our hypothesis is that clinicians displaying the poster-sized commitment letters will decrease their inappropriate antibiotic prescribing for ARIs as compared to clinicians in the control condition (with no posted letter).
| Condition | Intervention |
|---|---|
|
Acute Respiratory Infections (ARIs) |
Other: Posted commitment letter |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Health Services Research |
| Official Title: | Nudging Guideline-concordant Antibiotic Prescribing Using Public Commitments |
Resource links provided by NLM:
Further study details as provided by University of Southern California:
Primary Outcome Measures:
- Rate of inappropriate antibiotic prescribing for patients with acute respiratory infections [ Time Frame: up to 12 months post intervention ] [ Designated as safety issue: No ]Using data from electronic health records, we will calculate clinician antibiotic prescribing rates for antibiotic-inappropriate ARI diagnoses: acute nasopharyngitis (ICD-9 460.x), acute laryngitis without obstruction (465.8), acute laryngopharyngitis (465.0), acute bronchitis (466.x), acute upper respiratory infections of other multiple sites (465.8), acute upper respiratory infections not otherwise specified (465.9), bronchitis not specified as acute or chronic (490.x), non-streptococcal pharyngitis (462.xx), and influenza with other respiratory manifestations (487.1). To control for temporal trends in antibiotic prescribing and provider-fixed effects, we will fit a logistic mixed effects model that predicts inappropriate antibiotic prescribing as a function of study arm and an indicator for baseline versus intervention period (a difference-in-differences regression).
| Enrollment: | 14 |
| Study Start Date: | February 2012 |
| Estimated Study Completion Date: | February 2013 |
| Primary Completion Date: | May 2012 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: Posted commitment letter
The poster-sized (18x24 inches) commitment letter, written at the 8th grade reading-level and displayed in English and Spanish, emphasize clinician commitment to guidelines for appropriate antibiotic prescribing and explain why antibiotics are not appropriate in many cases. These letters, featuring clinician photographs and signatures, are displayed in clinician exam rooms for a 16-week period.
|
Other: Posted commitment letter |
|
No Intervention: Control
Usual care with no posted letters.
|
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Criteria
Inclusion Criteria:
- Medical professionals licensed to provide care and prescribe medications (including antibiotics)
- Treating adult patients (18 years of age and older) from 5 Los Angeles community clinics
Exclusion Criteria:
- none
Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT01767064
Locations
| United States, California | |
| QueensCare Family Clinics | |
| Los Angeles, California, United States, 90027 | |
Sponsors and Collaborators
University of Southern California
Investigators
| Principal Investigator: | Jason N Doctor, Ph.D. | University of Southern California |
More Information
No publications provided
| Responsible Party: | University of Southern California |
| ClinicalTrials.gov Identifier: | NCT01767064 History of Changes |
| Other Study ID Numbers: | USCalifornia, RC4AG039115 |
| Study First Received: | January 10, 2013 |
| Last Updated: | January 10, 2013 |
| Health Authority: | United States: Institutional Review Board |
Keywords provided by University of Southern California:
|
ARIs, antibiotics, public commitment, quality improvement |
Additional relevant MeSH terms:
|
Respiratory Tract Infections Infection Respiratory Tract Diseases Anti-Bacterial Agents |
Anti-Infective Agents Therapeutic Uses Pharmacologic Actions |
ClinicalTrials.gov processed this record on May 23, 2013