Decreasing Inappropriate Antibiotic Prescribing to Improve Patient Safety and Care
Jeffrey A. Linder, M.D., M.P.H.
Chief of the Division of General Internal Medicine and Geriatrics
Michael A. Gertz Professor of Medicine
“Inappropriate antibiotic prescribing exposes patients unnecessarily to the adverse effects of these medications and contributes to the creation of drug-resistant bacteria. Thanks to funding from AHRQ, we’re able to better understand clinician prescribing and develop interventions that improve antibiotic use."
Appropriate prescribing of antibiotics has been a key focus of research by Jeffrey A. Linder, M.D., M.P.H., Chief of the Division of General Internal Medicine and Geriatrics and the Michael A. Gertz Professor of Medicine at Northwestern University, for nearly 15 years.
In a new study that Dr. Linder presented at Infectious Disease Week 2018, he analyzed more than 500,000 prescriptions from 514 outpatient clinics and found that clinicians prescribed antibiotics without an infection-related diagnosis nearly half of the time. But he is working to change that practice.
Dr. Linder’s AHRQ-funded work continues to help advance the field of antibiotic stewardship by increasing the field’s understanding of how antibiotics are prescribed in a variety of clinical settings, including through electronic health records, and testing ways to improve that practice.
Dr. Linder started his AHRQ-funded research under a mentorship grant, which he used to design the “Improving Care for Acute Respiratory Infection” project. That project led to the development of electronic medical record-based “Smart Forms" to help primary care providers improve treatment for acute respiratory infections (ARIs). These forms standardized visit documentation, included clinical guidelines, and provided patient education materials. The Smart Forms also showed promise for increasing diagnostic accuracy and reducing unnecessary antibiotic prescriptions for ARIs when tested in clinical trials.
ARIs are the most common reason for ambulatory visits and account for about half of antibiotic prescribing in the United States. However, clinical guidelines generally discourage prescribing antibiotics for ARIs because these infections are usually caused by viruses, which don’t respond to antibiotics. Antibiotics are generally only used for an ARI if it’s known that bacteria are causing the infection.
Building in ways to help clinicians prescribe antibiotics appropriately at the point of care, for ARIs and other conditions, is an important step in preserving the long-term effectiveness of these drugs. The more antibiotics are used, the more bacteria become resistant to them.
Dr. Linder leveraged the experience he gained in his mentorship grant to launch another AHRQ-funded study that developed and implemented a quality dashboard to track patient data and provide metrics on clinician prescribing. This gave clinicians real-time feedback on their antibiotic prescribing patterns and best practices.
Dr. Linder’s more recent research has focused on the breadth and depth of inappropriate antibiotic prescriptions for ARIs across multiple medical settings. In an AHRQ-funded study, he demonstrated that, despite decades of educational efforts and guidelines designed to improve appropriate antibiotic prescribing for acute bronchitis, for which antibiotics are not necessary, primary care and emergency department physicians still inappropriately prescribed antibiotics for this condition 71 percent of the time between 1996 and 2010. More recently, together with collaborators, he found that inappropriate antibiotic prescriptions given to adults younger than 65 decreased by 12 percent, indicating that newer initiatives may be having some positive impact on clinician prescribing behavior.
Along with a national group of collaborators, Dr. Linder has also been applying behavioral economic and social psychology principles to decrease inappropriate antibiotic prescribing. The group found that certain interventions reduced the rate of inappropriate prescriptions from 20 percent to 4 percent.
Dr. Linder is a standing member of the AHRQ Healthcare Safety and Quality Improvement Study Section. He continues to research ways to help clinicians use antibiotics appropriately to keep patients safe from the unintended consequences of the medications and to slow the development of antibiotic-resistant bacteria.
Principal Investigator: Jeffrey A. Linder, M.D., M.P.H., Michael A. Gertz Professor of Medicine and the Chief of the Division of General Internal Medicine and Geriatrics at Northwestern University
Institution: Brigham and Women’s Hospital and Northwestern University
Grantee Since: 2004
Type of Grant: Various
Consistent with its mission, AHRQ provides a broad range of extramural research grants and contracts, research training, conference grants, and intramural research activities. AHRQ is committed to fostering the next generation of health services researchers who can focus on some of the most important challenges facing our Nation's health care system.
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