Evidence map›Paper›PMID 27495917›Full record

Trial reportBMC infectious diseases2016

Behavioral interventions to reduce inappropriate antibiotic prescribing: a randomized pilot trial.

Stephen D Persell, Jason N Doctor, Mark W Friedberg, Daniella Meeker, Elisha Friesema, Andrew Cooper, Ajay Haryani, Dyanna L Gregory, Craig R Fox, Noah J Goldstein and 1 more

Registry-linked trialOpen access · goldAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC infectious diseases, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01454960 (Use of Behavioral Economics to Improve Treatment of Acute Respiratory Infections), which is not on this map. Cited by 44 papers, 13 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
44citing papers in PubMed, 13 pooled it
5.2field-weighted citation impact, top 4% 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.

NCT01454960 nacompletednot on this map

Use of Behavioral Economics to Improve Treatment of Acute Respiratory Infections (Pilot Study)

TypeinterventionalSponsorUniversity of Southern CaliforniaRan2011 to 2014Enrolled28ConditionsAcute Respiratory Infections (ARIs)ArmsClinical Decision Support: Accountable Justification, Audit and Feedback: Peer Comparison, CDS Order Sets: Suggested Alternatives
3 · Its place in the literature

Who cites it

44 citing papers in PubMed, 13 syntheses or guidelines pooled it, 90 citations in OpenAlex.

  1. Pooled it
  2. Audit and Feedback Interventions for Antibiotic Prescribing in Primary Care: A Systematic Review and Meta-analysis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025
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  15. Improving Hand Hygiene Behavior Using a Novel Theory-Based Intervention During the COVID-19 Pandemic.Annals of behavioral medicine : a publication of the Society of Behavioral Medicine · 2022
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 7 institutions in 1 country.

Stephen D PersellDivision of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA. spersell@nm.org.
Jason N DoctorUSC Schaeffer Center for Health Policy and Economics, University of Southern California, 3335 S. Figueroa Street, Unit A, Los Angeles, CA, 90089-7273, USA.
Mark W FriedbergDivision of General Internal Medicine and Primary Care, Brigham and Women's Hospital; Harvard Medical School, 1620 Tremont Street, BC-3-2X, Boston, MA, 02120, USA.
Daniella MeekerUSC Schaeffer Center for Health Policy and Economics, University of Southern California, 3335 S. Figueroa Street, Unit A, Los Angeles, CA, 90089-7273, USA.
Elisha FriesemaDivision of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA.
Andrew CooperDivision of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA.
Ajay HaryaniDivision of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA.
Dyanna L GregoryDivision of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA.
Craig R FoxDepartment of Psychology, UCLA Anderson School of Management; David Geffen School of Medicine at UCLA, UCLA, 110 Westwood Plaza D-511, Los Angeles, CA, 90095, USA.
Noah J GoldsteinDepartment of Psychology, UCLA Anderson School of Management; David Geffen School of Medicine at UCLA, UCLA, 110 Westwood Plaza D-511, Los Angeles, CA, 90095, USA.
Jeffrey A LinderDivision of General Internal Medicine and Primary Care, Brigham and Women's Hospital; Harvard Medical School, 1620 Tremont Street, BC-3-2X, Boston, MA, 02120, USA.
Northwestern University · USAnderson University - South Carolina · USBrigham and Women's Hospital · USHarvard University · USRAND Corporation · USUCLA Health · USUniversity of Southern California · 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

backgroundClinicians frequently prescribe antibiotics inappropriately for acute respiratory infections (ARIs). Our objective was to test information technology-enabled behavioral interventions to reduce inappropriate antibiotic prescribing for ARIs in a randomized controlled pilot test trial.

methodsPrimary care clinicians were randomized in a 2 × 2 × 2 factorial experiment with 3 interventions: 1) Accountable Justifications; 2) Suggested Alternatives; and 3) Peer Comparison. Beforehand, participants completed an educational module. Measures included: rates of antibiotic prescribing for: non-antibiotic-appropriate ARI diagnoses, acute sinusitis/pharyngitis, all other diagnoses/symptoms of respiratory infection, and all three ARI categories combined.

resultsWe examined 3,276 visits in the pre-intervention year and 3,099 in the intervention year. The antibiotic prescribing rate fell for non-antibiotic-appropriate ARIs (24.7 % in the pre-intervention year to 5.2 % in the intervention year); sinusitis/pharyngitis (50.3 to 44.7 %); all other diagnoses/symptoms of respiratory infection (40.2 to 25.3 %); and all categories combined (38.7 to 24.2 %; all p < 0.001). There were no significant relationships between any intervention and antibiotic prescribing for non-antibiotic-appropriate ARI diagnoses or sinusitis/pharyngitis. Suggested Alternatives was associated with reduced antibiotic prescribing for other diagnoses or symptoms of respiratory infection (odds ratio [OR], 0.62; 95 % confidence interval [CI], 0.44-0.89) and for all ARI categories combined (OR, 0.72; 95 % CI, 0.54-0.96). Peer Comparison was associated with reduced prescribing for all ARI categories combined (OR, 0.73; 95 % CI, 0.53-0.995).

conclusionsWe observed large reductions in antibiotic prescribing regardless of whether or not study participants received an intervention, suggesting an overriding Hawthorne effect or possibly clinician-to-clinician contamination. Low baseline inappropriate prescribing may have led to floor effects.

trial registrationClinicalTrials.gov: NCT01454960 .

Indexed as

BehaviorPhysicians, Primary CarePractice Patterns, Physicians'Acute DiseaseAdultAnti-Bacterial AgentsDecision MakingDecision Support Systems, ClinicalEducation, Medical, ContinuingFemaleHumansInappropriate PrescribingInterprofessional RelationsMaleMiddle AgedPharyngitisAnti-Bacterial AgentsAcute respiratory infectionsAntibioticsBehavioral economicsClinical decision supportSocial psychology

Identifiers

PMID27495917
PMCPMC4975897
OpenAlexW2502284157

What OpenQuestion holds

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LicenceCC BY
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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.