Effect of the Behavioral Economics Based Measure to Contain Antibiotics Use: A Case of a General Hospital in Pattani

Abstract

Objective: To evaluate the effect of behavioral economics based measure to contain antibiotics use by comparing antibiotic prescribing rate and expenditure before and after intervention. Methods: This study was pre-post single group quasi-experimental research assessing effectiveness of the intervention based on behavioral economics. Intervention was feedback to each individual prescriber on his/her antibiotic prescribing rate with two different feedback frequencies, i.e. quarterly feedback for 8 quarters (October 2018–September 2020) followed by monthly feedback for 6 months (October 2020-March 2021). The antibiotic prescribing rates were compared between pre and post intervention in 4 diseases in which there was evidence that antibiotic therapy was not required according to the project on rational use of antibiotics including traumatic wound (FTW), respiratory infection (RI), acute diarrhea (AD) and antibiotic prophylaxis in vaginal delivery of normal term labor (APL). The segmented regression analysis of interrupted time series was employed. Results: Feedback to prescribing physician immediately reduced antibiotic prescribing rate in FTW, RI, and AD, and immediately reduced antibiotic expenditure in FTW, RI, AD and APL, but did not reach statistically significant levels. Trend of antibiotic prescribing rate in FTW significantly decreased by 1.89% per quarter (95%CI: -2.72 to -1.07), while that of antibiotic expenditure significantly decreased by 2,935 bath per quarter (95%CI: -4,427 to -1,442). Conclusion: The single intervention of information feedback to individual prescriber reduces physicians’ antibiotic prescribing rate and expenditures in some diseases. Other behavioral economics based measures should be designed and implemented in conjunction with information feedback measures to increase effectiveness in reducing the rate of antibiotic prescribing in hospitals.