title: Prescriber preferences for behavioural economics interventions to improve treatment of acute respiratory infections: a discrete choice experiment.
abstract: OBJECTIVE
  To elicit prescribers' preferences for behavioural economics interventions designed to reduce inappropriate antibiotic prescribing, and compare these to actual behaviour.
  
  
  METHODS
  Discrete choice experiment (DCE).
  
  
  METHODS
  47 primary care centres in Boston and Los Angeles.
  
  
  METHODS
  234 primary care providers, with an average 20 years of practice.
  
  
  METHODS
  Results of a behavioural economic intervention trial were compared to prescribers' stated preferences for the same interventions relative to monetary and time rewards for improved prescribing outcomes. In the randomised controlled trial (RCT) component, the 3 computerised prescription order entry-triggered interventions studied included: Suggested Alternatives (SA), an alert that populated non-antibiotic treatment options if an inappropriate antibiotic was prescribed; Accountable Justifications (JA), which prompted the prescriber to enter a justification for an inappropriately prescribed antibiotic that would then be documented in the patient's chart; and Peer Comparison (PC), an email periodically sent to each prescriber comparing his/her antibiotic prescribing rate with those who had the lowest rates of inappropriate antibiotic prescribing. A DCE study component was administered to determine whether prescribers felt SA, JA, PC, pay-for-performance or additional clinic time would most effectively reduce their inappropriate antibiotic prescribing. Willingness-to-pay (WTP) was calculated for each intervention.
  
  
  RESULTS
  In the RCT, PC and JA were found to be the most effective interventions to reduce inappropriate antibiotic prescribing, whereas SA was not significantly different from controls. In the DCE however, regardless of treatment intervention received during the RCT, prescribers overwhelmingly preferred SA, followed by PC, then JA. WTP estimates indicated that each intervention would be significantly cheaper to implement than pay-for-performance incentives of $200/month.
  
  
  CONCLUSIONS
  Prescribing behaviour and stated preferences are not concordant, suggesting that relying on stated preferences alone to inform intervention design may eliminate effective interventions.
  
  
  BACKGROUND
  NCT01454947; Results.
authors.affiliation: University of Southern California Leonard D. Schaeffer Center for Health Policy & Economics, Los Angeles, California, USA.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Gong
authors.affiliation: University of Southern California Leonard D. Schaeffer Center for Health Policy & Economics, Los Angeles, California, USA.
authors.forename: Joel W
authors.initials: JW
authors.lastname: Hay
authors.affiliation: University of Southern California Leonard D. Schaeffer Center for Health Policy & Economics, Los Angeles, California, USA University of Southern California Keck School of Medicine, Los Angeles, California, USA.
authors.forename: Daniella
authors.initials: D
authors.lastname: Meeker
authors.affiliation: University of Southern California Leonard D. Schaeffer Center for Health Policy & Economics, Los Angeles, California, USA.
authors.forename: Jason N
authors.initials: JN
authors.lastname: Doctor
keywords: antibiotic prescribing; conjoint analysis; discrete choice; revealed preference; stated preference