Peer Comparison Reports Result in Dramatic Drop in Fluoroquinolone Prescriptions

In the fight to decrease the use of antibiotics, health care systems and public health officials have tried a number of strategies, from better educational offerings to antibiotic tracking and stewardship programs. Now, a new study suggests another type of data might be an important piece of the puzzle: peer prescribing comparison reports.

The new research, published in the Journal of the American College of Clinical Pharmacy, makes the case for using peer comparison data to evaluate the impact of such reports on fluoroquinolone prescription rates at 16 community hospitals in western Florida.

John M. Allen, PharmD, a clinical assistant professor at the University of Florida’s College of Pharmacy, said over the course of the year, physicians who were told how their prescription rates compared to their peers tended to decrease the number of fluoroquinolone prescriptions they wrote.

“Previously published data suggest the act of antibiotic prescribing is not only a clinical action, but also a social action as well,” he told Contagion^®. “Our peer comparison reports highlight the need by many prescribers not to be viewed as an ‘outlier’ compared to other prescribers in the same specialty group.”

Fluoroquinolones were chosen as the focus of the study because they are commonly used, have a well-known adverse event profile, and often are prescribed in spite of the availability of other less toxic therapeutic options, Allen and colleagues indicated.

The investigators tracked fluoroquinolone prescriptions for the entire 2017 calendar year, dividing the results into 3 cohorts: internal medicine/hospitalists/family medicine, intensivists/pulmonologists, and infectious disease specialists. Each quarter, practitioners who were identified as outliers due to their high prescription volume were shown peer comparison reports, though the clinicians were not aware that of the status as outliers. In addition to the data, the physicians were also provided with educational materials designed to help curb their prescription rates.

The message got through. Over the course of the year, fluoroquinolone use at the hospitals dropped by 29%, and the investigators found no significant increases in prescribing rates of other antibiotics, indicating that the physicians were decreasing their antibiotic prescription rate, rather than simply shifting from fluoroquinolones to other categories of antibiotics. Allen said he and his fellow investigators specifically sought to design the study to avoid merely affecting an antibiotic shift. Among the evidence that it worked was a drop in antibiotics in 2 prime categories of over-prescription: urinary tract infection and chronic obstructive pulmonary disease.

“The other finding that jumped out was that the decrease in [fluoroquinolone] use occurred across facilities regardless of their baseline [ luoroquinolone] use, suggesting that the reports had benefits at both high and low-[fluoroquinolone] use facilities,” he added.

Allen said although the study highlights the importance of social factors when it comes to prescribing habits, he also believes the study succeeded because they chose to use the information to inform—rather than shame—physicians with unusually high fluoroquinolone prescribing rates.

“[W]e purposefully chose not to ‘weaponize’ the data, or use it in a punitive fashion,” he said. “The comparison information was simply used as a benchmarking tool to make prescribers fully aware of their degree of [fluoroquinolone] use compared [with] peer prescribers.”