Trial Outcomes & Findings for Nudging Guideline-concordant Antibiotic Prescribing Using Public Commitments (NCT NCT01767064)

Results Overview

Using data from electronic health records, we will calculate clinician antibiotic prescribing rates for antibiotic-inappropriate ARI diagnoses: acute nasopharyngitis (ICD-9 460.x), acute laryngitis without obstruction (465.8), acute laryngopharyngitis (465.0), acute bronchitis (466.x), acute upper respiratory infections of other multiple sites (465.8), acute upper respiratory infections not otherwise specified (465.9), bronchitis not specified as acute or chronic (490.x), non-streptococcal pharyngitis (462.xx), and influenza with other respiratory manifestations (487.1). To control for temporal trends in antibiotic prescribing and provider-fixed effects, we will fit a logistic mixed effects model that predicts inappropriate antibiotic prescribing as a function of study arm and an indicator for baseline versus intervention period (a difference-in-differences regression).

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

14 participants

Primary outcome timeframe

up to 12 months post intervention

Results posted on

2017-08-10

Participant Flow

Participant milestones

Participant milestones
Measure	Posted Commitment Letter The poster-sized (18x24 inches) commitment letter, written at the 8th grade reading-level and displayed in English and Spanish, emphasize clinician commitment to guidelines for appropriate antibiotic prescribing and explain why antibiotics are not appropriate in many cases. These letters, featuring clinician photographs and signatures, are displayed in clinician exam rooms for a 16-week period. Posted commitment letter	Control Usual care with no posted letters.
Overall Study STARTED	7	7
Overall Study COMPLETED	7	7
Overall Study NOT COMPLETED	0	0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Race and Ethnicity were not collected from any participant.

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure	Posted Commitment Letter n=7 Participants The poster-sized (18x24 inches) commitment letter, written at the 8th grade reading-level and displayed in English and Spanish, emphasize clinician commitment to guidelines for appropriate antibiotic prescribing and explain why antibiotics are not appropriate in many cases. These letters, featuring clinician photographs and signatures, are displayed in clinician exam rooms for a 16-week period. Posted commitment letter	Control n=7 Participants Usual care with no posted letters.	Total n=14 Participants Total of all reporting groups
Age, Continuous	53 years STANDARD_DEVIATION 12.9 • n=7 Participants	55 years STANDARD_DEVIATION 9.5 • n=7 Participants	54.3 years STANDARD_DEVIATION 10.64 • n=14 Participants
Sex: Female, Male Female	5 Participants n=7 Participants	6 Participants n=7 Participants	11 Participants n=14 Participants
Sex: Female, Male Male	2 Participants n=7 Participants	1 Participants n=7 Participants	3 Participants n=14 Participants
Race and Ethnicity Not Collected	—	—	0 Participants Race and Ethnicity were not collected from any participant.
Region of Enrollment United States	7 participants n=7 Participants	7 participants n=7 Participants	14 participants n=14 Participants

PRIMARY outcome

Timeframe: up to 12 months post intervention

Population: clinicians

Using data from electronic health records, we will calculate clinician antibiotic prescribing rates for antibiotic-inappropriate ARI diagnoses: acute nasopharyngitis (ICD-9 460.x), acute laryngitis without obstruction (465.8), acute laryngopharyngitis (465.0), acute bronchitis (466.x), acute upper respiratory infections of other multiple sites (465.8), acute upper respiratory infections not otherwise specified (465.9), bronchitis not specified as acute or chronic (490.x), non-streptococcal pharyngitis (462.xx), and influenza with other respiratory manifestations (487.1). To control for temporal trends in antibiotic prescribing and provider-fixed effects, we will fit a logistic mixed effects model that predicts inappropriate antibiotic prescribing as a function of study arm and an indicator for baseline versus intervention period (a difference-in-differences regression).

Outcome measures

Outcome measures
Measure	Posted Commitment Letter n=7 Participants The poster-sized (18x24 inches) commitment letter, written at the 8th grade reading-level and displayed in English and Spanish, emphasize clinician commitment to guidelines for appropriate antibiotic prescribing and explain why antibiotics are not appropriate in many cases. These letters, featuring clinician photographs and signatures, are displayed in clinician exam rooms for a 16-week period. Posted commitment letter	Control n=7 Participants Usual care with no posted letters.
Inappropriate Antibiotic Prescribing for Patients With Acute Respiratory Infections (ARI)	33.7 inappropriate prescribing events Interval 25.1 to 43.1	52.7 inappropriate prescribing events Interval 44.2 to 61.9

Adverse Events

Posted Commitment Letter

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Control

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Jason Doctor

USCalifornia

Phone: 213.821.8142

Email: [email protected]

Results disclosure agreements

Principal investigator is a sponsor employee
Publication restrictions are in place