You don’t plan to prescribe unnecessary antibiotics, but we know it happens. Why? and How do we stop it?
Flu season is in full swing. Your waiting room is bursting at the seams with sniffling, coughing patients. Most need fluids and rest, a few could benefit from anti-virals, but they expect the magical cure: antibiotics.
and more often than not, we give it to them . . .
Unnecessary antibiotics are actually worse than doing nothing.
We know this. We know it can lead to more severe problems for the individual patient as well as the greater medical community. Antibiotics kill necessary bacteria within our bodies in addition to the infections.
Unnecessary antibiotics can also lead to allergic reactions and the creation of antibiotic resistant bugs. Super diseases kill 23,000 patients a year according to an article from the New York Times on overprescribing antibiotics.Antibiotics are kind of medical magic, but when prescribed unnecessarily, are creating health nightmares. Click To Tweet
Approximately, one-third of all antibiotic prescriptions are unnecessary, according to researchers at the CDC, and nearly one-half of all outpatient antibiotic prescriptions are inappropriate.
While recent research from UCLA and Harvard show that advanced practitioners, like physician assistants and nurse practitioners, provide quality of care comparable to physicians, a CDC study shows that NPs and PAs are no better at over-prescribing antibiotics. In fact, we’re slightly more likely to do so.
We know better! So why are we still doing it?
One potential reason may be that PAs and NPs are seeing more of the kinds of cases that often seek antibiotics unnecessarily. Another reason is that programs aimed at reducing antibiotic prescriptions have been primarily targeted at physicians alone.
But overwhelmingly, providers at every level are prescribing inappropriate or unnecessary antibiotics.
We have to ask WHY in order to practice more effectively.We know better, so WHY are we STILL prescribing unnecessary antibiotics? and how can we stop? Click To Tweet
Recent studies show that when pharmaceutical companies financially compensate physicians for prescribing medications that those doctors are more likely to prescribe their medications. Even when doctors believe they acting without bias, we find that even the proverbial free lunch affects their prescribing.
Peter Loftus writes in the Wall Street Journal about recent JAMA findings that demonstrate free meals influence prescribing. It is often unconscious bias in favor of the medication discussed by a friendly face in a personal setting.
Some voluntary restrictions have prevented for-profit pharmaceutical companies’ gross manipulation of doctors. However, even small perks are inherently manipulative towards that name brand medication.
While this bias is true for all kinds of name brand medications not just antibiotics, it doesn’t explain why we find it so hard to stop prescribing generic antibiotics in the face of overwhelming evidence that it’s an unsafe practice.
We get tired.
The first few patients with viral illnesses get a rested, patient practitioner. We are willing to carefully explain the reasoning behind refusing to prescribe an unnecessary medication.
However, hours into a shift that is growing busier with each urgent patient newly wedged into the schedule, a difficult patient sees a provider who starts to surrender battles to win the war. Subconsciously, we give in and prescribe an antibiotic for a similar patient/ complaint who was denied earlier. We get worn down by the sheer number of times we make the same argument over and over.
What should we do?
First, we need to acknowledge if we are, in fact, part of the problem. Take ownership of all our prescribing practices.
Secondly, make a concerted effort to make some small changes in your practice.
Tips to Avoiding the Unnecessary Antibiotics Prescription:
- In each exam room, place a visible, signed pledge to prescribe more thoughtfully.
- Patient education pamphlets and posters about the differences between bacterial and viral infections and appropriate treatments for each.
- Based on diagnosis, electronic pop-up on medical charts requiring additional explanation for antibiotic prescriptions to include in patient files.
- Monthly peer review of prescription rates to compare individual provider prescribing rates.
- Daily personal review of prescription necessity, efficacy, and appropriateness.
Governmental mandates and oversight can’t fix this problem without creating more problems.
We each have to take steps to reduce unnecessary antibiotics with our patients.
New York Times. 25 March 2016.
Japsen, Bruce. “Nurse Practitioners, PAs No More Wasteful Than Physicians.” Forbes. 20 June 2016.
Loftus, Peter. “Even Cheap Meals Influence Doctors’ Drug Prescriptions, Study Suggests.” Wall Street Journal. 20 June 2016.