Dr. Pirofski noted that it’s nice to see evidence of the benefits of electronic health records, as putting them in place is typically a major undertaking. "It will be very interesting if good studies are done to determine how much that watchdog effect is driving people’s behavior. If it is, then I think the electronic component is absolutely essential because it’s the only way that you can really generate that data and data that people will believe."
That said, face-to-face interaction should not be underestimated in such interventions, she maintained. "The personal interaction, I believe, is really what drove the early success of some of these antibiotic stewardships, because medicine can be very lonely. If somebody comes in and chats you up a little bit, you feel like you are more in tune with what’s going on. ... My own feeling is that personal interaction always drives change better than these other things," said Dr. Pirofski, who is chief of the division of infectious diseases at Albert Einstein College of Medicine, New York.
Ascertaining the cost effectiveness of the intervention would be complicated because of copayment and reimbursement issues, according to Dr. Gerber, but "most of these broad-spectrum agents are between five and ten times more expensive than the narrow-spectrum agents." He predicted that, as insurers move toward a bundled-payment model, costs will get greater attention. "Maybe insurance companies won’t reimburse for broad-spectrum agents if we can show that recommendations should be followed, and there are no differences in outcomes," he said.
The investigators plan to assess the impact of the intervention on health outcomes and will monitor the durability of its efficacy, Dr. Gerber said. "We are going to follow up for at least another year, now that there are no more feedback reports coming in, to see if it continues or if people revert back to their initial prescribing patterns," he explained. In addition, they are interviewing participating clinicians to obtain their viewpoints on prescribing and auditing, along with suggestions for improving the intervention.
Neither Dr. Gerber nor Dr. Pirofski disclosed any relevant conflicts of interest.