Effect of Behavioral Interventions on Inappropriate Antibiotic Prescribing Among Primary Care Practices: A Randomized Clinical Trial
Daniella Meeker,Daniella Meeker,Jeffrey A. Linder,Jeffrey A. Linder,Craig R. Fox,Mark W. Friedberg,Mark W. Friedberg,Mark W. Friedberg,Stephen D. Persell,Noah J. Goldstein,Tara K. Knight,Joel W. Jw Hay,Jason N. Doctor +12 more
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Among primary care practices, the use of accountable justification and peer comparison as behavioral interventions resulted in lower rates of inappropriate antibiotic prescribing for acute respiratory tract infections.Abstract:
Importance Interventions based on behavioral science might reduce inappropriate antibiotic prescribing. Objective To assess effects of behavioral interventions and rates of inappropriate (not guideline-concordant) antibiotic prescribing during ambulatory visits for acute respiratory tract infections. Design, Setting, and Participants Cluster randomized clinical trial conducted among 47 primary care practices in Boston and Los Angeles. Participants were 248 enrolled clinicians randomized to receive 0, 1, 2, or 3 interventions for 18 months. All clinicians received education on antibiotic prescribing guidelines on enrollment. Interventions began between November 1, 2011, and October 1, 2012. Follow-up for the latest-starting sites ended on April 1, 2014. Adult patients with comorbidities and concomitant infections were excluded. Interventions Three behavioral interventions, implemented alone or in combination:suggested alternativespresented electronic order sets suggesting nonantibiotic treatments;accountable justificationprompted clinicians to enter free-text justifications for prescribing antibiotics into patients’ electronic health records;peer comparisonsent emails to clinicians that compared their antibiotic prescribing rates with those of “top performers” (those with the lowest inappropriate prescribing rates). Main Outcomes and Measures Antibiotic prescribing rates for visits with antibiotic-inappropriate diagnoses (nonspecific upper respiratory tract infections, acute bronchitis, and influenza) from 18 months preintervention to 18 months afterward, adjusting each intervention’s effects for co-occurring interventions and preintervention trends, with random effects for practices and clinicians. Results There were 14 753 visits (mean patient age, 47 years; 69% women) for antibiotic-inappropriate acute respiratory tract infections during the baseline period and 16 959 visits (mean patient age, 48 years; 67% women) during the intervention period. Mean antibiotic prescribing rates decreased from 24.1% at intervention start to 13.1% at intervention month 18 (absolute difference, −11.0%) for control practices; from 22.1% to 6.1% (absolute difference, −16.0%) for suggested alternatives (difference in differences, −5.0% [95% CI, −7.8% to 0.1%];P = .66 for differences in trajectories); from 23.2% to 5.2% (absolute difference, −18.1%) for accountable justification (difference in differences, −7.0% [95% CI, −9.1% to −2.9%];P Conclusions and Relevance Among primary care practices, the use of accountable justification and peer comparison as behavioral interventions resulted in lower rates of inappropriate antibiotic prescribing for acute respiratory tract infections. Trial Registration clinicaltrials.gov Identifier:NCT01454947read more
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European Position Paper on Rhinosinusitis and Nasal Polyps 2020
Wytske Fokkens,Valerie J. Lund,Joachim Mullol,Claus Bachert,Isam Alobid,Fuad M. Baroody,Noam A. Cohen,Anders Cervin,Richard Douglas,Philippe Gevaert,Christos Georgalas,Herman Goossens,Richard J. Harvey,Peter Hellings,Claire Hopkins,Nick Jones,Guy Joos,Livije Kalogjera,Bob Kern,Marek L. Kowalski,David Price,Herbert Riechelmann,Rodney J. Schlosser,Brent A. Senior,Mike Thomas,Elina Toskala,Richard Louis Voegels,De Yun Wang,Peter-John Wormald +28 more
TL;DR: The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012 and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery.
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Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study
TL;DR: A comprehensive classification scheme of diagnosis codes in ICD-10-CM (international classification of diseases-clinical modification, 10th revision) could facilitate future efforts to comprehensively measure outpatient antibiotic appropriateness in the US, and it could be adapted for use in other countries that use I CDM codes.
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Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits
Kristin N. Ray,Zhuo Shi,Courtney A. Gidengil,Courtney A. Gidengil,Sabrina J. Poon,Lori Uscher-Pines,Ateev Mehrotra,Ateev Mehrotra +7 more
TL;DR: At DTC telemedicine visits, children with ARIs were more likely to receiving antibiotics and less likely to receive guideline-concordant antibiotic management compared to children at PCP visits and urgent care visits.
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