How EHRs and Behavioral Interventions Can Fight Antibiotic-Resistant Superbugs

Digital behavioral interventions can cut down the kind of overprescribing that empowers antibiotic-resistant bacteria — superbugs — in a cost-effective manner, according to a new study.

The report, published this week in the Journal of General Internal Medicine, found that three behavioral economics interventions can reduce the number of inappropriate antibiotic prescriptions, increasing quality of life and decreasing antibiotic resistance and its associated costs.

Researchers from the University of Southern California (USC) Schaeffer Center for Health Policy and LA BioMed, a California-based innovation incubator, undertook the research to help curb a growing public health crisis. Antibiotic-resistant superbugs have infected more than 2 million people worldwide, in part because roughly half of American outpatient antibiotic prescriptions are unnecessary, according to the study.

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“Healthcare needs more studies such as these, targeted to identify successful initiatives that are both cost-saving and life-saving,” said David Meyer, Ph.D., who leads LA BioMed.

For the study, researchers analyzed three interventions, including: 1) Suggested alternatives, which leverage digital clinical decision support tools to suggest treatments that don’t use antibiotics; 2) Accountable justification, which requires prescribers to justify their use of antibiotics in a patient’s electronic health record (EHR); and 3) Peer comparison, which entails sending emails to clinicians regarding how their prescribing rates stack up to their colleagues.

These three tactics had already proved effective in reducing the number of erroneous antibiotic prescriptions over an 18-month period.

So, USC and LA BioMed researchers designed a study using the 30-year Markov model, with inputs from the literature and U.S. Centers for Disease Control and Prevention surveillance data. They homed in on 45-year-old adults who had shown signs of acute respiratory infections, for which patients sometimes inappropriately receive antibiotic prescriptions.

Then providers received the three aforementioned digital tools, along with training on guidelines for treatments for acute respiratory infections.

Measuring discounted costs, quality-adjusted life years and cost-effectiveness, researchers found that the strategies were not only successful but also adept at cutting costs. The total cost of each training intervention was $178.21, while suggested alternatives ran $173.22, accountable justification ran $172.82 and peer comparison ran $172.52, according to the study. What’s more, the training group experienced 14.68 quality-adjusted life years, falling short of 14.73, 14.74 and 14.74 for the three groups that received behavioral economic interventions.

The study and others like it could have big consequences. Public health officials are growing increasingly concerned about the potential effects of antibiotic resistance. Some experts have claimed that the phenomenon could result in the next great outbreak. But, as this study suggests, part of the answer could lie in the EHR and a provider’s email account.

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