How Behavioural Economics can help reduce GP over-prescription of antibiotics

A campaign in Australia to reduce prescribing antibiotics in the primary care setting has been largely successful, according to The Medical Republic. In part, this has been down to using a key behavioural science principle called the Hawthorne Effect.

Over prescription of antibiotics poses a major concern to the general public as it can lead to antibiotic-resistant bacteria (‘super bugs’) and shorten the lifespan and efficacy of many of the antibiotics currently used.  According to Dr. Dartnell who was involved in this study, “In 2014, 46% of the Australian public was prescribed antibiotics [at least once] and at least half of these prescriptions may have been unnecessarily issued.”

Program managers should take note of the successful strategies implemented to change the behaviour of GPs.  In this scenario, facts alone were not enough to change behaviour.  GPs have long been aware of the risks of overprescribing antibiotics in terms of broader public health but perhaps thought their prescribing habits were similar to that of their colleagues. 

The campaign to fight unnecessary antibiotic prescribing adopted a multi-faceted approach; efforts to curb prescribing rates utilized the Hawthorne Effect by sending letters to GPs that compared their prescribing habits to that of their peers.  The Hawthorne Effect is a cognitive bias that assumes that people behave differently when they feel as if they are being observed.  So when GPs began to receive letters comparing their prescribing habits to others, they realized that maybe what they thought was “normal” wasn’t normal at all.    This comparative feedback mechanism challenged the social norms around prescribing antibiotics, making GPs think twice before writing a script.

This strategy combined with national education programs involving multiple stakeholders, consumer advertising, and clinical audits had a big impact.  Six months after the launch of the campaign in 2012, antibiotic dispensing was down 20% from the forecasted amount; or in other terms, roughly 127,000 fewer antibiotics were being dispensed on average per month. 

This campaign shows that GP behaviour is malleable.  In this example, all it took was increasing the visibility of GP prescribing habits for them to challenge their own practice of medicine.  As a program manager employing behavioural economics, you should focus your efforts on moving away from facts to emotion and be explicit about your intended goal (in this case, “I want GPs to prescribe fewer antibiotics”).  Think:  How can I make this objective more emotionally tangible?  How can I make behaviour more transparent and socially engaging?  How can I make my desired behaviour change the simplest option?