Doctors Prescribe More Antibiotics Later in The Day

Doctors prescribe more antibiotics for respiratory infections later in the day, a new study says.  

For the first time, researchers at Brigham and Women's Hospital, Boston, found that doctors in primary care often prescribe unnecessary antibiotics for acute respiratory infections (ARI) as the work day progresses. During the morning and afternoon clinic sessions, the doctors tire themselves and this increases their rate of antibiotic prescribing.

"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."

In this study, the researchers combined billing and electronic health record (EHR) data of those patients who visited 23 various primary care practices over the course of 17 months. Using the billing codes they identified the visit diagnoses and using EHRs they identified the visit times, chronic illnesses as well as the antibiotics prescribed.

They evaluated more than 21,000 ARI visits made by adults and this occurred during two four-hour sessions i.e. 8 a.m. to noon, and 1 p.m. to 5 p.m. They noticed that throughout the morning and afternoon clinic sessions, the antibiotic prescribing rate increased.

"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 finding was documented in JAMA Internal Medicine.