Boston, MA—Clinicians make many patient care decisions each day, and the cumulative demand of these decisions may make inappropriate choices more likely later in the day. In primary care, doctors often prescribe unnecessary antibiotics for acute respiratory infections (ARI). Researchers at Brigham and Women's Hospital (BWH) in Boston found that doctors appeared to "wear down" during their morning and afternoon clinic sessions, and antibiotic prescribing rates increased. These findings are published in JAMA Internal Medicine on October 6, 2014.
"Clinic is very demanding and doctors get worn down over the course of their clinic sessions," explained Jeffrey A. Linder, MD, MPH, a physician and researcher in the Division of General Medicine and Primary Care at BWH and lead author of this study. "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."
The researchers merged billing and electronic health record (EHR) data for patient visits to 23 different primary care practices over the course of 17 months. They then identified visit diagnoses using billing codes and, using EHRs, identified visit times, antibiotic prescriptions and chronic illnesses. They analyzed over 21-thousand ARI visits by adults, which occurred during two four-hour sessions, 8a.m. to noon and 1p.m. to 5p.m. The researchers found that antibiotic prescribing increased throughout the morning and afternoon clinic sessions.
"This corresponds to about 5 percent more patients receiving antibiotics at the end of a clinic session compared to the beginning, "explained Linder. "Remedies for this problem might include different schedules, shorter sessions, more breaks or maybe even snacks."
The researchers note that future studies are needed to clarify the sources of the problem and test corresponding solutions.
This research was supported by grant RC4 AG039115 from the National Institutes of Health/National Institute on Aging.
Brigham and Women's Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare. BWH has more than 3.5 million annual patient visits, is the largest birthing center in New England and employs nearly 15,000 people. The Brigham's medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in patient care, quality improvement and patient safety initiatives, and its dedication to research, innovation, community engagement and educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, more than 1,000 physician-investigators and renowned biomedical scientists and faculty supported by nearly $650 million in funding. For the last 25 years, BWH ranked second in research funding from the National Institutes of Health (NIH) among independent hospitals. BWH continually pushes the boundaries of medicine, including building on its legacy in transplantation by performing a partial face transplant in 2009 and the nation's first full face transplant in 2011. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information and resources, please visit BWH's online newsroom.
JAMA Internal Medicine