Nudging Guideline-concordant Antibiotic Prescribing Using Public Commitments

This study is ongoing, but not recruiting participants.
Sponsor:
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
  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
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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 by University of Southern California

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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
Antibiotics, Antitubercular
Anti-Infective Agents
Therapeutic Uses
Pharmacologic Actions
Antitubercular Agents

ClinicalTrials.gov processed this record on September 16, 2014