To Lower Antibiotic Prescribing, Write Letters Comparing Physicians To Their Peers

A behavioral economics trial conducted in Australia shows that applying behavioral insights to letters sent to physicians who over-prescribe antibiotics can help reduce over-prescription.



For the randomized controlled trial, the Australian Government's CMO sent letters to 6,649 general practitioners whose prescribing rates were in the top 30 percent for their region. The letters were sent on June 9, 2017.


The physicians received one of four different versions of the letter from the CMO:

• Education-only letter
• Education with peer comparison
• Peer comparison with graph
• Peer comparison with delayed prescribing letter

The researchers found that an estimated 126,352 fewer prescriptions were filled over the six-month period as a result of the letters. Compared to physicians who did not receive a letter, the peer comparison letters resulted in a 9.3 to 12.3 percent reduction in prescription rates over six months. However, the education-only letter reduced antibiotic prescriptions by 3.2 percent over same time period.

The peer comparison with graph reduced prescription rates by 12.3 percent over the six-month period.

"[The results] suggest antibiotic stewardship programs can maximize their effects by using peer comparison feedback to assist doctors to reflect on their prescribing practices," the researchers concluded.

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