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The Effect of Expert Feedback on Antibiotic Prescribing in Pediatrics: Experimental Evidence

Author

Listed:
  • Kerstin Eilermann

    (Cologne Graduate School in Management, Economics, and Social Sciences (CGS), Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany)

  • Katrin Halstenberg

    (Medical Faculty and University Hospital, Department of Pediatrics, University of Cologne, Cologne, Germany)

  • Ludwig Kuntz

    (Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany
    Operations Management Group, Judge Business School, University of Cambridge, Cambridge, UK)

  • Kyriakos Martakis

    (Medical Faculty and University Hospital, Department of Pediatrics, University of Cologne, Cologne, Germany
    Department of International Health, Care and Public Health Research Institute, School CAPHRI, Maastricht University, Maastricht, the Netherlands
    Department of Pediatric Neurology, University Children’s Hospital (UKGM) and Medical Faculty, Justus Liebig University of Giessen, Giessen, Germany)

  • Bernhard Roth

    (Medical Faculty and University Hospital, Department of Pediatrics, University of Cologne, Cologne, Germany)

  • Daniel Wiesen

    (Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany)

Abstract

Background. 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. Objective. To analyze the causal effect of descriptive expert feedback (and individual characteristics) on physicians’ antibiotic prescribing decisions in pediatrics. Design. We employed a randomized, controlled framed field experiment, in which German pediatricians ( n =73) decided on the length of first-line antibiotic treatment for routine pediatric cases. In the intervention group ( n =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 ( n =20), who stated the length of antibiotic therapies they would choose for the routine cases. Pediatricians’ characteristics were elicited in a comprehensive questionnaire. Results. 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. Conclusion. 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.

Suggested Citation

  • Kerstin Eilermann & Katrin Halstenberg & Ludwig Kuntz & Kyriakos Martakis & Bernhard Roth & Daniel Wiesen, 2019. "The Effect of Expert Feedback on Antibiotic Prescribing in Pediatrics: Experimental Evidence," Medical Decision Making, , vol. 39(7), pages 781-795, October.
    • Handle: RePEc:sae:medema:v:39:y:2019:i:7:p:781-795
    DOI: 10.1177/0272989X19866699
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    References listed on IDEAS

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    2. Beilfuss, Svetlana & Linde, Sebastian & Norton, Brandon, 2022. "Accountable care organizations and physician antibiotic prescribing behavior," Social Science & Medicine, Elsevier, vol. 294(C).
    3. Nadja Kairies-Schwarz & Claudia Souček, 2020. "Performance Pay in Hospitals: An Experiment on Bonus–Malus Incentives," IJERPH, MDPI, vol. 17(22), pages 1-29, November.
    4. Thomas Allen & Dorte Gyrd-Hansen & Søren Rud Kristensen & Anne Sophie Oxholm & Line Bjørnskov Pedersen & Mario Pezzino, 2022. "Physicians under Pressure: Evidence from Antibiotics Prescribing in England," Medical Decision Making, , vol. 42(3), pages 303-312, April.
    5. Waibel, Christian & Wiesen, Daniel, 2021. "An experiment on referrals in health care," European Economic Review, Elsevier, vol. 131(C).
    6. Brosig-Koch, Jeannette & Hennig-Schmidt, Heike & Kairies-Schwarz, Nadja & Kokot, Johanna & Wiesen, Daniel, 2020. "Physician performance pay: Experimental evidence," HERO Online Working Paper Series 2020:3, University of Oslo, Health Economics Research Programme.

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