PharmacoEconomics & Outcomes News 696, p5 - 15 Feb 2014

Gently nudging towards improvedantibiotic prescribing

A gentle "nudging" approach, based on the principle ofpublic commitment to reduce the inappropriateprescribing of antibiotics, is "comparable to priorquality-improvement efforts involving more intensiveand costlier designs", according to the results of a studypublished in JAMA Internal Medicine.1

Dr Daniella Meeker and co-workers set out todetermine whether their simple, low-cost behaviouralnudge would affect antibiotic prescribing rates inprimary care. Their nudge consisted of a poster-sizedletter (displayed in examination rooms for 12 weeks)from clinicians committing to follow the guidelines forappropriate antibiotic prescribing. The study involvedrandomising seven clinicians (who treated 449 patients)to the poster intervention and seven clinicians (505patients) to a control group.

After controlling for baseline rates, the researchersfound that inappropriate antibiotic prescribing was 20%less in the intervention group than in controls(p = 0.02). Extrapolating their data to all of the US, theyestimated that their nudge could prevent 2.6 millionunnecessary antibiotic prescriptions, and save anestimated $US70 million in drug costs each year.

In an invited commentary, Dr Brad Spellberg saysthat, although the impact of the intervention was"modest", it was "significant" as well as being easy toimplement.2 However, he cautions that even with thisgentle nudge, the majority of baseline inappropriateantibiotic use still remained after the intervention (atalmost 34%) and that "other novel approaches will beneeded to further reduce antibiotic prescriptions".1. Meeker D, et al. Nudging Guideline-Concordant Antibiotic Prescribing: A

Randomized Clinical Trial. JAMA Internal Medicine : 27 Jan 2014. Availablefrom: URL: http://dx.doi.org/10.1001/jamainternmed.2013.14191.

2. von Wartburg M, et al. The long-term cost-effectiveness of varenicline (12-weekstandard course and 12 + 12-week extended course) vs. other smoking cessationstrategies in Canada. International Journal of Clinical Practice : 29 Jan 2014.Available from: URL: http://doi.org/10.1111/ijcp.12363.

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PharmacoEconomics & Outcomes News 15 Feb 2014 No. 6961173-5503/14/0696-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved