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Use of a Behavioral Economic Intervention to Reduce Antibiotic Prescription for Upper Respiratory Infections

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03464279
Recruitment Status : Completed
First Posted : March 14, 2018
Last Update Posted : May 2, 2018
Sponsor:
Collaborators:
LAC+USC Medical Center
Los Angeles County Department of Public Health
Information provided by (Responsible Party):
Catherine A. Sarkisian, University of California, Los Angeles

Brief Summary:
In an effort to implement Choosing Wisely guidelines and decrease patient harm, we will implement and evaluate a clinician audit-feedback and behavioral "nudge" initiative to reduce low-value antibiotics for URIs. Using a quasi-experiment (pre-post) design, antibiotic prescriptions for URI at LAC+USC Urgent Care Center (intervention site) vs. Olive View-UCLA Urgent Care Center (control site) will used to test the effects of behavioral "nudge" on antibiotic prescribing.

Condition or disease Intervention/treatment Phase
Antibiotics Upper Respiratory Infections Safety-Net Hospitals Behavioral Economics Choosing Wisely Behavioral: Nudge using Behavioral Economic Interventions Behavioral: Standard Practices to Reduce Health System Antibiotic Prescription Not Applicable

Detailed Description:

National prescription rates for low-value antibiotics for uncomplicated upper respiratory infections (URIs) remain unacceptably high, including at LAC+USC Medical Center—one of the largest safety net medical centers in the U.S. Using a quasi-experiment (pre-post) design, antibiotic prescriptions for URI at LAC+USC Urgent Care Center (intervention site) vs. Olive View-UCLA Urgent Care Center (control site) will be compared. A three-part intervention at LAC+USC consists of (1) the urgent care medical director emailing Choosing Wisely® guidelines and presented journal club to all 16 urgent care clinicians, and then (2) leveraging EHR performance data to provide individual clinicians with case-specific audit-feedback (both via emails and in-person while precepting nurse practitioners) on low-value antibiotic prescribing, and (3) using a behavioral "nudge", urgent care clinicians will sign a large poster committing to avoid prescribing low-value antibiotics for uncomplicated URIs, which will be displayed in the clinic. In contrast, the control site (Urgent Care Center at Olive View-Medical Center) will receive Centers for Disease Control prescription pads for non-antibiotic treatments (e.g., decongestants) that offer patients alternatives to antibiotics, in a broader health system effort to reduce antibiotic prescribing. Patient with URIs (e.g., acute bronchitis, bronchitis NOS, excluding guideline-based red flags such as COPD, HIV) will be identified using electronic health record clinical billable data and low-value antibiotic prescriptions rates per visit will be monitored at both sites. Differences in prescriptions rates will be determined using an interrupted time-series analysis comparing utilization between sites using a repeated measures logistic regression model.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 2500 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: Single (Participant)
Primary Purpose: Health Services Research
Official Title: Use of a Behavioral Economic Intervention to Reduce Antibiotic Prescription for Upper Respiratory Infections
Actual Study Start Date : May 29, 2015
Actual Primary Completion Date : March 30, 2018
Actual Study Completion Date : March 30, 2018

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Antibiotics

Arm Intervention/treatment
Experimental: Intervention Site
The intervention Site (Urgent Care Center at LAC+USC Medical Center) will receive a three part intervention consisting of (1) Email Choosing Wisely® guidelines and presented journal club to all 16 urgent care clinicians, (2) leveraging EHR performance data to provide individual clinicians with case-specific audit-feedback (both via emails and in-person while precepting nurse practitioners) on low-value antibiotic prescribing, and (3) using a behavioral "nudge", urgent care clinicians will sign a large poster committing to avoid prescribing low-value antibiotics for uncomplicated URIs displayed in the clinic.
Behavioral: Nudge using Behavioral Economic Interventions
Active Comparator: Control Site
The control site (Urgent Care Center at Olive View-Medical Center) will receive broader health system efforts to reduce antibiotic prescribing consisting of Center for Disease Control prescription pads for non-antibiotic treatments (e.g., decongestants) that offer patients alternatives to antibiotics.
Behavioral: Standard Practices to Reduce Health System Antibiotic Prescription



Primary Outcome Measures :
  1. Change in Low-value antibiotic prescriptions rates per visit [ Time Frame: 1 year ]
    Changes in inappropriate antibiotic prescriptions rates per visit before and after implementation of intervention at both sites


Secondary Outcome Measures :
  1. Coding Shift (ie, a shift in use of diagnostic codes to conditions that are more antibiotic appropriate) in URI diagnosis [ Time Frame: 1 year ]
    Change frequency of proportion of antibiotic appropriate diagnoses before intervention and after at both sites.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • all patient receiving treatment for Upper Respiratory Infections (defined by ICD codes EHR billable codes) at both LAC+USC Medical Center Urgent Care or Olive View-UCLA Medical Center

Exclusion Criteria:

  • Patients not receiving treatment for Upper Respiratory Infections at both LAC+USC Medical Center Urgent Care or Olive View-UCLA Medical Center

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03464279


Locations
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United States, California
Los Angeles County +University of Southern California (LAC+USC) Medical Center
Los Angeles, California, United States, 90033
Sponsors and Collaborators
University of California, Los Angeles
LAC+USC Medical Center
Los Angeles County Department of Public Health

Publications:
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Responsible Party: Catherine A. Sarkisian, Professor in Residence, University of California, Los Angeles
ClinicalTrials.gov Identifier: NCT03464279    
Other Study ID Numbers: IRB #16-000932-004
First Posted: March 14, 2018    Key Record Dates
Last Update Posted: May 2, 2018
Last Verified: April 2018

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Infection
Communicable Diseases
Respiratory Tract Infections
Respiratory Tract Diseases
Anti-Bacterial Agents
Antibiotics, Antitubercular
Anti-Infective Agents
Antitubercular Agents