Physician Feedback Reduces Antibiotic Prescribing for Uncomplicated Upper Respiratory Tract Infection in the Emergency Department.

Objectives: Inappropriate antibiotic prescribing for acute upper respiratory tract infections (URTIs) is a significant problem in emergency departments (EDs) worldwide. In this study, we separately evaluated the effectiveness of physician feedback and patient education in reducing antibiotic prescribing for URTIs in the ED setting. Methods: We conducted a quasi-experimental study across four large adult EDs in Singapore from January 2021 to December 2023. After a baseline period (18 months), two EDs were randomly assigned to either implement physician feedback or patient education for six months (intervention period 1), and all EDs subsequently implemented both interventions in the next six months (intervention period 2). Hierarchical segmented logistic regression was used to assess the effectiveness of the interventions in reducing weekly antibiotic prescribing for URTIs. Results: In the two EDs that implemented physician feedback first, there was a significant decrease in the trend of weekly antibiotics prescribed (AOR 0.981 [95% CI (0.964, 0.998)]) compared to the last 6 months of the pre-intervention period. Adding patient education in the next phase (intervention period 2) did not further reduce the trend of weekly antibiotics prescribed. For the second group of two EDs that implemented patient education first, there was no significant reduction in the weekly antibiotic prescribing trend during intervention period 1. With the addition of physician feedback, a significant decline in the trend of weekly antibiotics prescribed was observed in intervention period 2 (AOR 0.921 [95% CI (0.903,0.940)]). Conclusions: Physician feedback alone can reduce antibiotic prescribing for URTIs in EDs. Further research is warranted to assess the effectiveness of patient education involving multi-modal educational channels co-created with patients.