Nudging Guideline-concordant Antibiotic Prescribing Using Public Commitments

Acute Respiratory Infections (ARIs) Clinical Trial

Official title:

Nudging Guideline-concordant Antibiotic Prescribing Using Public Commitments

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT01767064
• Other study ID #: USCalifornia
• Secondary ID: RC4AG039115
• Status: Active, not recruiting
• Phase: N/A
• First received: January 10, 2013
• Last updated: January 10, 2013
• Start date: February 2012
• Est. completion date: February 2013

Study information

• Verified date: January 2013
• Source: University of Southern California
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Institutional Review Board
• Study type: Interventional

Clinical Trial Summary

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).

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 14
• Est. completion date: February 2013
• Est. primary completion date: May 2012
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years and older

Eligibility

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:

Study Design

Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Health Services Research

Related Conditions & MeSH terms

• Acute Respiratory Infections (ARIs)
• Respiratory Tract Infections

Intervention

Other:
• Posted commitment letter

Locations

Country	Name	City	State
United States	QueensCare Family Clinics	Los Angeles	California

Sponsors (3)

Lead Sponsor	Collaborator
University of Southern California	National Institute on Aging (NIA), National Institutes of Health (NIH)

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Rate of inappropriate antibiotic prescribing for patients with acute respiratory infections	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).	up to 12 months post intervention	No