Antibiotic stewardship from computer alerts shows promise, study finds

A new study found that provider education and persistent intervention led to gains in antibiotic stewardship, but overall results faded over time.

Unnecessary antibiotic prescriptions can harm both individual patients and the general population. A new study in the American Journal of Managed Care suggested persistent intervention may help stem the practice.

Antimicrobial resistance among a new breed of superbugs underscores the urgency around antibiotic stewardship. In general, however, doctors have continued to overprescribe these medications, and researchers continue to struggle to find the roots of the problem, according to Adam Sharp, M.D., a researcher with the Kaiser Permanente Southern California Department of Research & Evaluation and an ER doctor at the Kaiser Permanente Los Angeles Medical Center.

“Health systems are discovering that stopping a common behavior, like prescribing antibiotics, can be even more difficult than spreading the use of a new test or treatment,” said Sharp. He recently headed a study that used computer alerts to warn doctors when a course of antibiotics was not the best treatment for their patients. That relatively simple intervention cut the odds of a prescription for sinusitis by 22%.

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The study, which tracked almost 22,000 cases of initial acute sinusitis, found that while educating providers appeared to have a substantial initial impact on prescription rates, that effect faded over time. Also, while the odds a patient would be prescribed antibiotics dropped significantly, the overall reduction in antibiotic use remained relatively small, resulting in only a 2% absolute reduction by the end of the study period.

The study’s authors attributed the bulk of their intervention’s effectiveness to the larger reduction in prescriptions seen immediately following patient education, and clinical decision support helped to maintain a small portion of those gains.

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This suggests the industry still has work to do to improve antibiotic stewardship. The authors cited the stubbornness of the problem among their most prominent findings, writing that the diminution of the positive results of physician education over time “reinforces that sustained improvement in clinical practice is difficult to achieve.”