A New Approach to Antibiotic Prescriptions
High rates of antibiotic prescription and misuse are of great concern in the United States. In 2014, over 250 million antibiotics were prescribed to patients not admitted to a hospital, and at least 30% of those were unnecessary. Additionally, the rate of inappropriate prescriptions is believed to be around 50%. Both overuse and misuse of antibiotics contribute to antibiotic resistance, where surviving bacteria multiply to form a resistant population. With time, this may cause a patient to no longer respond to an antibiotic, making treatment more difficult. By 2050, researchers estimate that drug-resistant infections can lead to over 10 millions lives lost per year. The Centers for Disease Control and Prevention (CDC) outlines policies and guidelines in an effort of antibiotic stewardship, which works to measure and improve antibiotic prescriptions. However, the issue of overprescription remains and needs to be addressed.
A recent study investigated whether combining the individual prescription recommendations of multiple professionals resulted in improved adherence to international guidelines. Improper prescriptions can include prescribing the wrong type of antibiotic, prescribing the wrong duration of treatment, or prescribing an antibiotic when none is even needed. Since a common issue is prescribing an antibiotic for too long, the study focused on the duration of the antibiotic course. The study was carried out in Europe, and the prescribers were infection specialists.
A recent study investigated whether combining the individual prescription recommendations of multiple professionals resulted in improved adherence to international guidelines. Improper prescriptions can include prescribing the wrong type of antibiotic, prescribing the wrong duration of treatment, or prescribing an antibiotic when none is even needed. Since a common issue is prescribing an antibiotic for too long, the study focused on the duration of the antibiotic course. The study was carried out in Europe, and the prescribers were infection specialists.
Using wisdom of crowds, individual healthcare professionals’ recommendations would be taken into account prior to prescribing an antibiotic.
Image Source: National Cancer Institute
Unlike a group method, where prescribers would discuss their decision, the researchers tested a method called “wisdom of crowds,” where the individual decisions were combined to reach a conclusion. The researchers believed this method would be more effective than group discussion, where social hierarchy may discourage participation.
The best approach was found to be using the groups’ median response. With this method, improvement was seen with as little as three prescribers. However, in some situations, no method was found to be effective. This was attributed to a lack of guidelines regarding prescriptions for certain diseases, and the prescribers' possible misunderstanding of the scenario.
Previous interventions for prescribers included restrictions and persuasive approaches, which often involved education. However, these methods require large-scale changes, such as educational programs, and results were found to vary. In the case of wisdom of crowds, no large-scale educational programs would be necessary and fear of poor patient outcomes amongst individual prescribers would be reduced.
While the study focused on duration of antibiotic treatment, further investigation of how the wisdom of crowds could be effectively applied to scenarios regarding the type or necessity of antibiotics is still required. Different levels of prescribers, such as primary care or urgent care, should also be investigated. The variety of healthcare environments, which includes outpatient consultations and hospital wards, also brings into question the applicability of this method. Since wisdom of crowds requires multiple healthcare professionals to look over an individual’s chart, there is a limit of time and resources.
Overall, this research addresses the need for standardized antibiotic prescription and demonstrates the effectiveness and limitations of wisdom of crowds. Further research should aim to see how effective wisdom of crowds would be in the United States healthcare system, and more research on antibiotic prescriptions in general is needed to improve the guidelines and ensure adherence to them. An improved system of prescribing antibiotics would not only reduce the costs and risks to an individual patient, but it would also minimize antibiotic resistance, saving millions lives in the near future.
The best approach was found to be using the groups’ median response. With this method, improvement was seen with as little as three prescribers. However, in some situations, no method was found to be effective. This was attributed to a lack of guidelines regarding prescriptions for certain diseases, and the prescribers' possible misunderstanding of the scenario.
Previous interventions for prescribers included restrictions and persuasive approaches, which often involved education. However, these methods require large-scale changes, such as educational programs, and results were found to vary. In the case of wisdom of crowds, no large-scale educational programs would be necessary and fear of poor patient outcomes amongst individual prescribers would be reduced.
While the study focused on duration of antibiotic treatment, further investigation of how the wisdom of crowds could be effectively applied to scenarios regarding the type or necessity of antibiotics is still required. Different levels of prescribers, such as primary care or urgent care, should also be investigated. The variety of healthcare environments, which includes outpatient consultations and hospital wards, also brings into question the applicability of this method. Since wisdom of crowds requires multiple healthcare professionals to look over an individual’s chart, there is a limit of time and resources.
Overall, this research addresses the need for standardized antibiotic prescription and demonstrates the effectiveness and limitations of wisdom of crowds. Further research should aim to see how effective wisdom of crowds would be in the United States healthcare system, and more research on antibiotic prescriptions in general is needed to improve the guidelines and ensure adherence to them. An improved system of prescribing antibiotics would not only reduce the costs and risks to an individual patient, but it would also minimize antibiotic resistance, saving millions lives in the near future.
Featured Image Source: Christina Victoria Craft
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