BACKGROUND: Systemic corticosteroids are frequently used inappropriately to treat patients with acute respiratory tract illnesses (ARTI) despite a lack of efficacy and risks.
OBJECTIVE: To develop an intervention which effectively decreases corticosteroid use for ARTI encounters among outpatient clinicians.
DESIGN: A randomized controlled trial in which the clinicians in primary care clinics that were randomized to intervention clinics were compared to clinicians in control group clinics. The 6-month trial began in March 2023.
SETTING: Outpatient primary care clinics within Southeast Louisiana.
PARTICIPANTS: High steroid utilizing clinicians with =5% baseline ARTI steroid injection rate caring for outpatient adults.
INTERVENTION: Intervention clinicians were assigned a voluntary 1-h online course and received a monthly personalized report of their steroid usage.
MAIN MEASURE: Monthly office visits with at least one ARTI diagnosis were evaluated for the rate of corticosteroid injection use. The effect of the intervention was assessed by a negative binomial regression model accounting for the repeated nature of the data collection.
KEY RESULTS: Sixty-one clinicians in the control clinic group and 75 in the intervention clinic group were identified as high-utilizing clinicians. At baseline, intervention and control clinicians' average inappropriate steroid injection rates were similar: 16 and 15%, respectively. Steroid injection use among intervention clinicians decreased significantly compared to controlled clinicians (5.5 (95% CI 3.8, 7.9) vs. 10.7 (95% CI 7.7, 14.8) per 100 patients; p = 0.03) - resulting in nearly a 50% reduction in inappropriate use.
CONCLUSION: This innovative implementation study showed a clinically and statistically significant improvement in decreasing inappropriate steroid use. Our work helps lay the groundwork to advance adopting inappropriate corticosteroid use as a primary care and ARTI care quality metric.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
I was unaware of this regional propensity for clinicians to use corticosteroid injections for acute respiratory infections. On the other hand, I find urgent care facilities in my area frequently prescribe oral corticosteroids (“steroid bursts”) for self-limited illnesses like ARTIs. Perhaps an alert could lower rates of oral corticosteroids in a similar manner.
, McMaster University