Changing Physician Prescribing Behavior: The Community-Acquired Pneumonia Intervention Trial

Kim C. Coley, Susan J. Skledar , Michael J. Fine, Donald M. Yealy , Patrick P. Gleason , Michael L. Ryan, Wishwa Kapoor , and Robert A. Branch


Am J Health Syst Pharm. 2000;57(16) 

In This Article


We set out to change prescribing behavior in nonsevere CAP through a multifaceted program and to reduce antimicrobial costs without compromising patient outcomes. Our results demonstrate that the interventions we used were effective. These findings are consistent with previous results on the impact of multifaceted educational interventions on prescribing behavior.[13]

Our study differs in three ways from previous studies of prescribing intervention programs. First, our study was conducted in a tertiary care academic medical center, whereas most prior research has been conducted in outpatient clinics, group practices, and family practice units. These settings are relatively self-contained, with a smaller number of physicians involved in direct patient care. Our program did not target a specific physician service, specialty, or hospital unit but the entire medical center. Second, we evaluated both the clinical and economic impacts of our intervention. Few studies have examined how changing prescribing behavior affects patient outcomes.23 Our intervention program resulted in a significant decrease in total antimicrobial costs without compromising medical outcomes. Finally, we evaluated whether prescribing changes could be sustained after the intervention period ended.

Length of stay decreased during the intervention period. This finding was most likely due to secular trends in length of stay. (It is important, however, to demonstrate that such a program does not negatively affect length of stay.) We realized antimicrobial cost savings of approximately $60 per patient per admission. The total cost saving to our institution was not dramatic, since our tertiary care center admits relatively few patients with CAP. In community hospitals, larger savings may be realized.

A limitation of our study is that we did not measure the cost of the intervention program. This initiative was part of an ongoing program to improve prescribing practices at the institution. Although no additional costs were incurred by the program, resources were allocated for its implementation. Institutions without these baseline resources might incur significant costs in developing such a program.