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October 15, 2014
Unnecessary Antibiotics Prescribed More at End
of Clinician Workdays

Boston—If pharmacists have the sense that a lot of patients are picking up antibiotic prescriptions in the late afternoon and evening, here’s why: Clinicians are more likely to prescribe unnecessary antibiotics as their workday progresses, according to a new research letter.

Researchers from Brigham and Women’s Hospital in Boston suggest that doctors become victims of decision fatigue and are more likely to inappropriately prescribe antibiotics for acute respiratory infections (ARI) at the end of a long day. The report was published recently in JAMA Internal Medicine.

“Clinic is very demanding and doctors get worn down over the course of their clinic sessions,” explained lead author Jeffrey A. Linder, MD, MPH, a physician and researcher in the Division of General Medicine and Primary Care at BWH. “In our study we accounted for patients, the diagnosis and even the individual doctor, but still found that doctors were more likely to prescribe antibiotics later in their clinic session.”

For the study, billing and electronic health record (EHR) data were merged for patient visits to 23 different primary care practices over the course of 17 months. Billing codes were used to determine visit diagnoses while EHRs contained information on visit times, antibiotic prescriptions and chronic illnesses.

All-in-all more than 21,000 ARI visits by adults were analyzed, focusing on two 4-hour sessions—8 a.m. to noon and 1 p.m. to 5 p.m. Antibiotic prescribing increased throughout the morning and afternoon clinic sessions.

“Clinicians may prescribe unnecessary antibiotics—again the easy, safe option—due to perceived or explicit patient demand, a desire to do something meaningful for patients, a desire to conclude visits quickly, or an unrealistic fear of complications,” the authors hypothesize.

“This corresponds to about 5% more patients receiving antibiotics at the end of a clinic session compared to the beginning,” Linder noted. “Remedies for this problem might include different schedules, shorter sessions, more breaks or maybe even snacks.”

The researchers call for future studies to clarify the sources of the problem and test corresponding solutions.


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