Cologne Graduate School in Management, Economics, and Social Sciences (CGS), Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany.
Medical Faculty and University Hospital, Department of Pediatrics, University of Cologne, Cologne, Germany.
Med Decis Making. 2019 Oct;39(7):781-795. doi: 10.1177/0272989X19866699. Epub 2019 Aug 17.
Inappropriate prescribing of antibiotics, which is common in pediatric care, is a key driver of antimicrobial resistance. To mitigate the development of resistance, antibiotic stewardship programs often suggest the inclusion of feedback targeted at individual providers. Empirically, however, it is not well understood how feedback affects individual physicians' antibiotic prescribing decisions. Also, the question of how physicians' characteristics, such as clinical experience, relate to antibiotic prescribing decisions and to responses to feedback is largely unexplored. To analyze the causal effect of descriptive expert feedback (and individual characteristics) on physicians' antibiotic prescribing decisions in pediatrics. We employed a randomized, controlled framed field experiment, in which German pediatricians (=73) decided on the length of first-line antibiotic treatment for routine pediatric cases. In the intervention group (=39), pediatricians received descriptive feedback in form of an expert benchmark, which allowed them to compare their own prescribing decisions with expert recommendations. The recommendations were elicited in a survey of pediatric department directors (=20), who stated the length of antibiotic therapies they would choose for the routine cases. Pediatricians' characteristics were elicited in a comprehensive questionnaire. Providing pediatricians with expert feedback significantly reduced the length of antibiotic therapies by 10% on average. Also, the deviation of pediatricians' decisions from experts' recommendations significantly decreased. Antibiotic therapy decisions were significantly related to pediatricians' clinical experience, risk attitudes, and personality traits. The effect of feedback was significantly associated with physicians' experience. Our results indicate that descriptive expert feedback can be an effective means to guide pediatricians, especially those who are inexperienced, toward more appropriate antibiotic prescribing. Therefore, it seems to be suitable for inclusion in antibiotic stewardship programs.
在儿科护理中，抗生素的不适当处方很常见，这是导致抗生素耐药性的一个关键因素。为了减轻耐药性的发展，抗生素管理计划通常建议包括针对个别提供者的反馈。然而，从经验上看，人们并不清楚反馈如何影响个别医生的抗生素处方决策。此外，医生的特征（如临床经验）如何与抗生素处方决策以及对反馈的反应相关，这在很大程度上尚未得到探索。
分析描述性专家反馈（和个体特征）对儿科医生抗生素处方决策的因果效应。
我们采用了一项随机对照框架实地实验，德国儿科医生（=73 人）决定常规儿科病例一线抗生素治疗的时长。在干预组（=39 人）中，儿科医生收到了描述性反馈，形式为专家基准，使他们能够将自己的处方决策与专家建议进行比较。这些建议是在对儿科部门主任（=20 人）进行的调查中得出的，他们表示了他们在常规病例中会选择多长时间的抗生素治疗。儿科医生的特征是在一份综合问卷中收集的。
为儿科医生提供专家反馈平均将抗生素治疗的长度减少了 10%。此外，儿科医生决策与专家建议的偏差也显著降低。抗生素治疗决策与儿科医生的临床经验、风险态度和人格特征显著相关。反馈的效果与医生的经验显著相关。
我们的结果表明，描述性专家反馈可以是指导儿科医生的有效手段，尤其是对那些缺乏经验的医生，使他们更适当地开抗生素处方。因此，它似乎适合纳入抗生素管理计划。
