Evidence map›Paper›PMID 24474434›Full record

Trial reportJAMA internal medicine2014

Nudging guideline-concordant antibiotic prescribing: a randomized clinical trial.

Daniella Meeker, Tara K Knight, Mark W Friedberg, Jeffrey A Linder, Noah J Goldstein, Craig R Fox, Alan Rothfeld, Guillermo Diaz, Jason N Doctor

3 registry-linked trialsOpen access · greenAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in JAMA internal medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 164 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
164citing papers in PubMed, 9 pooled it
55.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01767064 nacompletednot on this map

Nudging Guideline-concordant Antibiotic Prescribing Using Public Commitments

TypeinterventionalSponsorUniversity of Southern CaliforniaRan2012 to 2013Enrolled14ConditionsAcute Respiratory Infections (ARIs)ArmsPosted commitment letter
NCT03464279 nacompletednot on this mapstarted 2015, after this paper: background citation

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

TypeinterventionalSponsorUniversity of California, Los AngelesRan2015 to 2018Enrolled2,500ConditionsAntibiotics, Upper Respiratory Infections, Safety-Net Hospitals, Behavioral EconomicsArmsNudge using Behavioral Economic Interventions, Standard Practices to Reduce Health System Antibiotic Prescription
NCT05138874 nacompletednot on this mapstarted 2022, after this paper: background citation

Improving Safe Antibiotic Prescribing in Telehealth: Evaluation of a Randomized Trial

TypeinterventionalSponsorUniversity of Southern CaliforniaRan2022 to 2023Enrolled6,581ConditionsAcute Respiratory Infection, TelehealthArmsTrending Feedback, Benchmark Peer Comparison Feedback, Private Commitment, Public Commitment
3 · Its place in the literature

Who cites it

164 citing papers in PubMed, 9 syntheses or guidelines pooled it, 331 citations in OpenAlex.

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  16. The Effect of Expert Feedback on Antibiotic Prescribing in Pediatrics: Experimental Evidence.Medical decision making : an international journal of the Society for Medical Decision Making · 2019
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104 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 6 institutions in 1 country.

Daniella MeekerRAND Corporation, Santa Monica, California.
Tara K KnightClinical Pharmacy and Pharmaceutical Economics and Policy, University of Southern California, Los Angeles.
Mark W FriedbergRAND Corporation, Boston, Massachusetts4Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts5Harvard Medical School, Boston, Massachusetts.
Jeffrey A LinderDivision of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts5Harvard Medical School, Boston, Massachusetts.
Noah J GoldsteinAnderson School of Management, University of California, Los Angeles.
Craig R FoxAnderson School of Management, University of California, Los Angeles.
Alan RothfeldCOPE Health Solutions, Los Angeles, California.
Guillermo DiazQueensCare Family Clinics, Los Angeles, California.
Jason N DoctorClinical Pharmacy and Pharmaceutical Economics and Policy, University of Southern California, Los Angeles.
Anderson University - South Carolina · USBrigham and Women's Hospital · USUniversity of Southern California · USCOPE Health Solutions · USRAND Corporation · USVenice Family Clinic · US

Funding

Use of Behavioral Economics to Improve Treatment of Acute Respiratory InfectionsRC4AG039115 · NIA · UNIVERSITY OF SOUTHERN CALIFORNIA · PI DOCTOR, JASON N. · 2010 to 2010
$11.5M
NIA NIH HHS RC4 AG039115
6 · The paper itself

Abstract

importance"Nudges" that influence decision making through subtle cognitive mechanisms have been shown to be highly effective in a wide range of applications, but there have been few experiments to improve clinical practice.

objectiveTo investigate the use of a behavioral "nudge" based on the principle of public commitment in encouraging the judicious use of antibiotics for acute respiratory infections (ARIs). DESIGN, SETTING, AND

participantsRandomized clinical trial in 5 outpatient primary care clinics. A total of 954 adults had ARI visits during the study timeframe: 449 patients were treated by clinicians randomized to the posted commitment letter (335 in the baseline period, 114 in the intervention period); 505 patients were treated by clinicians randomized to standard practice control (384 baseline, 121 intervention).

interventionsThe intervention consisted of displaying poster-sized commitment letters in examination rooms for 12 weeks. These letters, featuring clinician photographs and signatures, stated their commitment to avoid inappropriate antibiotic prescribing for ARIs. MAIN OUTCOMES AND MEASURES: Antibiotic prescribing rates for antibiotic-inappropriate ARI diagnoses in baseline and intervention periods, adjusted for patient age, sex, and insurance status.

resultsBaseline rates were 43.5% and 42.8% for control and poster, respectively. During the intervention period, inappropriate prescribing rates increased to 52.7% for controls but decreased to 33.7% in the posted commitment letter condition. Controlling for baseline prescribing rates, we found that the posted commitment letter resulted in a 19.7 absolute percentage reduction in inappropriate antibiotic prescribing rate relative to control (P = .02). There was no evidence of diagnostic coding shift, and rates of appropriate antibiotic prescriptions did not diminish over time. CONCLUSIONS AND RELEVANCE: Displaying poster-sized commitment letters in examination rooms decreased inappropriate antibiotic prescribing for ARIs. The effect of this simple, low-cost intervention is comparable in magnitude to costlier, more intensive quality-improvement efforts.

trial registrationclinicaltrials.gov identifier: NCT01767064.

Indexed as

Drug PrescriptionsGuideline AdherencePractice Guidelines as TopicPractice Patterns, Physicians'AdultAgedAnti-Bacterial AgentsHumansInappropriate PrescribingInfectionsMaleMiddle AgedPrimary Health CareAnti-Bacterial Agents

Identifiers

PMID24474434
PMCPMC4648560
OpenAlexW2105794235

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.