Impact of Education and Peer Comparison on Antibiotic Prescribing for Pediatric Respiratory Tract Infections

Abstract

Supplemental Digital Content is available in the text.

Improving antibiotic prescribing for pediatric acute respiratory tract infections: A cluster randomized trial to evaluate individual versus clinic feedback

“…In our prior work, 10 pediatric practices that received individual feedback viewable only by other clinicians in their practice significantly improved performance on URI, ABS, and AOM, reaching ≥ 90% performance for each and significant reduction in BSAP% within 18 months. 7 As anticipated, improvements were maintained for the postintervention year because data provision continued for both groups at the clinic level, and we had shown significant improvement with this intervention alone for the control group.…”

“…Similar changes have been seen with pediatric clinics and individual peer comparison. 7 We suspect that these changes reflect more appropriate diagnostic coding resulting from education, as suggested by others. 29,30 Total antibiotic prescribing changed little after the intervention, as expected, since we did not focus on prescribing reduction but rather on guideline-concordant care.…”

“…2 In ambulatory settings, audit and feedback has been shown to decrease inappropriate antibiotic prescribing and was recently recommended among the core elements of ambulatory stewardship. [3][4][5][6][7][8][9][10][11][12] Behavioral science research shows individual data provision for quality improvement may be more effective than group data. 13 A recent before-and-after, quasi-experimental quality improvement initiative in 22 pediatric clinics in our healthcare system showed marked improvement in guideline-concordant care for 3 acute respiratory tract infections (ARTIs) when individual peer comparison data were provided monthly over time.…”

“…13 A recent before-and-after, quasi-experimental quality improvement initiative in 22 pediatric clinics in our healthcare system showed marked improvement in guideline-concordant care for 3 acute respiratory tract infections (ARTIs) when individual peer comparison data were provided monthly over time. 7 However, provision of these individual feedback reports is time-and resourceconsuming and may not provide improvement over group feedback. In fact, we found no trials of ambulatory antimicrobial prescribing feedback comparing individual clinician performance with feedback on group performance.…”

Inter-prescriber variability in the decision to prescribe antibiotics to febrile patients attending primary care in Myanmar

“…Antimicrobial stewardship programmes in health facilities that target behaviour of high prescribing doctors such as peer comparison and feedback have the potential to reduce antibiotic overuse where there is high variation in antibiotic prescription among doctors. 18 , 19 Studies have shown variation of antibiotic prescription among primary care physicians and GPs in different countries 20–22 but data from Southeast Asia and low- and middle-income settings are limited. A failure to account for inter-prescriber variation in the design and analysis of antimicrobial stewardship studies may lead to inefficient study designs, inappropriate analysis and incorrect conclusions.…”