The Effect of Emphasizing Patient, Societal, and Institutional Harms of Inappropriate Antibiotic Prescribing on Physician Support of Financial Penalties: A Randomized Trial

Letters1 August 2017The Effect of Emphasizing Patient, Societal, and Institutional Harms of Inappropriate Antibiotic Prescribing on Physician Support of Financial Penalties: A Randomized TrialJoshua M. Liao, MD, MSc, Marilyn S. Schapira, MD, MPH, Amol S. Navathe, MD, PhD, Nandita Mitra, PhD, Arlene Weissman, PhD, and David A. Asch, MD, MBAJoshua M. Liao, MD, MScFrom University of Pennsylvania, Philadelphia, Pennsylvania; University of Pennsylvania and Philadelphia VA Medical Center, Philadelphia, Pennsylvania; University of Pennsylvania, Philadelphia, Pennsylvania; American College of Physicians, Philadelphia, Pennsylvania; University of Pennsylvania and Philadelphia VA Medical Center, Philadelphia, Pennsylvania., Marilyn S. Schapira, MD, MPHFrom University of Pennsylvania, Philadelphia, Pennsylvania; University of Pennsylvania and Philadelphia VA Medical Center, Philadelphia, Pennsylvania; University of Pennsylvania, Philadelphia, Pennsylvania; American College of Physicians, Philadelphia, Pennsylvania; University of Pennsylvania and Philadelphia VA Medical Center, Philadelphia, Pennsylvania., Amol S. Navathe, MD, PhDFrom University of Pennsylvania, Philadelphia, Pennsylvania; University of Pennsylvania and Philadelphia VA Medical Center, Philadelphia, Pennsylvania; University of Pennsylvania, Philadelphia, Pennsylvania; American College of Physicians, Philadelphia, Pennsylvania; University of Pennsylvania and Philadelphia VA Medical Center, Philadelphia, Pennsylvania., Nandita Mitra, PhDFrom University of Pennsylvania, Philadelphia, Pennsylvania; University of Pennsylvania and Philadelphia VA Medical Center, Philadelphia, Pennsylvania; University of Pennsylvania, Philadelphia, Pennsylvania; American College of Physicians, Philadelphia, Pennsylvania; University of Pennsylvania and Philadelphia VA Medical Center, Philadelphia, Pennsylvania., Arlene Weissman, PhDFrom University of Pennsylvania, Philadelphia, Pennsylvania; University of Pennsylvania and Philadelphia VA Medical Center, Philadelphia, Pennsylvania; University of Pennsylvania, Philadelphia, Pennsylvania; American College of Physicians, Philadelphia, Pennsylvania; University of Pennsylvania and Philadelphia VA Medical Center, Philadelphia, Pennsylvania., and David A. Asch, MD, MBAFrom University of Pennsylvania, Philadelphia, Pennsylvania; University of Pennsylvania and Philadelphia VA Medical Center, Philadelphia, Pennsylvania; University of Pennsylvania, Philadelphia, Pennsylvania; American College of Physicians, Philadelphia, Pennsylvania; University of Pennsylvania and Philadelphia VA Medical Center, Philadelphia, Pennsylvania.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L17-0102 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Physicians commonly prescribe antibiotics for uncomplicated upper respiratory infections despite consensus about their low value and efforts emphasizing their societal costs and harms (1, 2). To deter low-value services, policymakers have begun proposing financial penalties for physicians who prescribe them (3, 4).Objective: To determine whether physician support of financial penalties targeting inappropriate antibiotic prescribing is influenced by emphasis on patient, societal, or institutional harms of such prescribing.Methods and Findings: We conducted a Web-based survey among a panel of physicians identified by stratified random sampling to represent members of the American College of Physicians in the United States ...References1. American Board of Internal Medicine Foundation. Choosing Wisely. 2017. Accessed at www.choosingwisely.org on 16 April 2017. Google Scholar2. Rosenberg A, Agiro A, Gottlieb M, Barron J, Brady P, Liu Y, et al. Early trends among seven recommendations from the Choosing Wisely campaign. JAMA Intern Med. 2015;175:1913-20. [PMID: 26457643] doi:10.1001/jamainternmed.2015.5441 CrossrefMedlineGoogle Scholar3. Centers for Medicare & Medicaid Services. CMS response to public comments on non-recommended PSA-based screening measure. 2016. Accessed at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Downloads/eCQM-Development-and-Maintenance-for-Eligible-Professionals_CMS_PSA_Response_Public-Comment.pdf on 16 April 2017. Google Scholar4. Berwick DM. Avoiding overuse—the next quality frontier. Lancet. 2017. [PMID: 28077229] doi:10.1016/S0140-6736(16)32570-3 CrossrefMedlineGoogle Scholar5. Mafi JN, Wee CC, Davis RB, Landon BE. Comparing use of low-value health care services among U.S. advanced practice clinicians and physicians. Ann Intern Med. 2016;165:237-44. [PMID: 27322541]. doi:10.7326/M15-2152 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Pennsylvania, Philadelphia, Pennsylvania; University of Pennsylvania and Philadelphia VA Medical Center, Philadelphia, Pennsylvania; University of Pennsylvania, Philadelphia, Pennsylvania; American College of Physicians, Philadelphia, Pennsylvania; University of Pennsylvania and Philadelphia VA Medical Center, Philadelphia, Pennsylvania.Financial Support: By the Leonard Davis Institute of Health Economics at the University of Pennsylvania, which had no role in the study design, data collection, analysis, or interpretation of results.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L17-0102.This article was published at Annals.org on 20 June 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byLow value care is a health hazard that calls for patient empowermentProblem ÜberversorgungKey Features Underlying Low-Value Care RecommendationsSeeking care for back pain or upper respiratory infections?: Survey results to inform a safety net hospital Choosing Wisely® interventionPrimary care physicians' attitudes and perceptions towards antibiotic resistance and outpatient antibiotic stewardship in the USA: a qualitative studyTaking Action to Address Medical Overuse: Common Challenges and FacilitatorsHealth Care ValueOver prescribing of antibiotics for acute respiratory tract infections; a qualitative study to explore Irish general practitioners' perspectivesDevelopment of a Conceptual Map of Negative Consequences for Patients of Overuse of Medical Tests and TreatmentsLow-value care: an intractable global problem with no quick fixHarms of prescribing increase support of penalties 1 August 2017Volume 167, Issue 3Page: 215-216KeywordsAntibioticsDisclosureInstitutional review boardsInterquartile rangeLower back painMotivationPatientsRandomized trialsSub-specialty careUpper respiratory tract infections ePublished: 20 June 2017 Issue Published: 1 August 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. 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