Behavioral Economics and Ambulatory Antibiotic Stewardship: A Narrative Review

Assessment of Changes in Visits and Antibiotic Prescribing During the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use and the COVID-19 Pandemic

“… 1 , 2 , 3 Studies have reported that specific interventions may decrease ambulatory antibiotic prescribing, including educational interventions; electronic decision support; multimodal interventions; and behavioral economics nudges, including commitment posters, peer comparison feedback, and justification alerts. 20 , 21 , 22 The decreases in antibiotic prescribing seen in the Safety Program are similar to or greater than those shown in earlier trials. 23 , 24 , 25 , 26 These earlier studies were smaller and provided more practice support than the current project.…”

“…The AHRQ Safety Program appears to meet an important need in ambulatory care settings where total antibiotic prescriptions are high and AS implementation strategies have been limited . Studies have reported that specific interventions may decrease ambulatory antibiotic prescribing, including educational interventions; electronic decision support; multimodal interventions; and behavioral economics nudges, including commitment posters, peer comparison feedback, and justification alerts . The decreases in antibiotic prescribing seen in the Safety Program are similar to or greater than those shown in earlier trials .…”

Simple signature/countersignature shared-accountability quality improvement initiative to improve reliability of blood sample collection: an essential clinical task

“…To better meet the twin goals of low operational disruption and sustained behaviour change, the QI specialists employed behavioural economics strategies throughout this project, including in the selection of a transparent shared-accountability mechanism as the primary intervention and publication of a celebratory poster depicting the pilot and expansion ward stakeholders as a unified team. In the former instance, it was hoped that normative social pressure, similar to effects previously described for antibiotic prescribing patterns,17 would encourage form usage by both parties to avoid the appearance of delinquency. In the latter case, the celebratory poster was meant to leverage the IKEA effect, a behavioural economics concept named after the Swedish self-assembly furniture maker, in which individuals are known to impart greater value to things they produce rather than merely appropriate 18.…”

Less is more: Recommendations for achieving best practices in antibiotic use for acute upper respiratory infections

“…As mentioned, multiple factors have been theorized to contribute to the overprescription of antibiotics including perceived patient expectations, time pressures, and diagnostic uncertainties. 17 Addressing or alleviating these concerns may help guide methods to improve prescriber adherence to antibiotic treatment recommendations.…”

“…Although Zakharevich et al found that EDs had a lower percentage of inappropriate antibiotic than UCCs, we believe that there is room for improvement in both settings. As mentioned, multiple factors have been theorized to contribute to the overprescription of antibiotics including perceived patient expectations, time pressures, and diagnostic uncertainties 17 . Addressing or alleviating these concerns may help guide methods to improve prescriber adherence to antibiotic treatment recommendations.…”