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Neue Publikation in Medical Decision Making

Expert feedback improves antibiotic prescribing decisions in pediatrics

Especially inexperienced physicians can benefit from feedback on their individual prescribing decisions/ Publication in ‘Medical Decision Making’, co-authored by Kerstin Eilermann, Katrin Halstenberg, Ludwig Kuntz, Kyriakos Martakis, Bernhard Roth, and Daniel Wiesen

Expert feedback leads to more appropriate antibiotic therapy decisions, especially in less experienced physicians. This is the central result of an interdisciplinary study conducted by our department in collaboration with the Faculty of Medicine of the University of Cologne. The study, which uses a controlled experiment to investigate the causal effect of expert feedback on individual physicians’ antibiotic prescribing decisions, has been published in the journal Medical Decision Making. Below, you will find the link to access the paper.

Why is this topic relevant? | The excessive use of antibiotics contributes to the development of resistance, which increasingly endangers the effectiveness of antibiotic therapies. Nevertheless, antibiotics are still frequently prescribed without being therapeutically indicated and treatment courses are often excessively long. In addition to the development of resistance, this increases the risk of antibiotic-related adverse outcomes. Especially in children, the inappropriate use of antibiotics can have serious short- and long-term consequences for their health and their development.

What did we do? | In the experimental study with pediatricians, we investigated a behavioural approach to improving antibiotic prescribing.


A total of 73 pediatricians took part in the experimental study, in which treatment decisions for pediatric routine cases were examined in a controlled environment. The experiment consisted of three stages. At each stage, we asked participants to decide for 40 hypothetical patients whether and for how long they would prescribe antibiotics. At the beginning of the second stage, the participants were informed that they would receive expert feedback on their treatment decisions, which was based on recommendations by directors of pediatric departments at German hospitals. At the end of the second stage, we actually provided the feedback on their treatment decisions. Subjects could compare their average length of antibiotic therapies for the 40 cases with the experts’ recommendations.

While the announcement of feedback had no significant effect on prescribing decisions, the provision of expert feedback significantly reduced the length of antibiotic therapies by about one day on average (10 percent of the initially chosen length of therapies).  


Daniel Wiesen, who initiated the study, says: “We were surprised that a simple approach like providing expert feedback can have such a strong effect on physicians’ prescribing decisions. After the provision of feedback, the physicians chose shorter therapies. The treatment decisions were also more in line with expert and guideline recommendations. Thus, we can say that the provision of expert feedback has guided the physicians toward more appropriate antibiotic therapy decisions.”

Implications for practice? | The interdisciplinary project has shown that a simple ‘nudge’ (expert feedback) is a useful means to improve the prescribing behaviour of physicians. ‘Nudging’ is a method based on behavioural theory with the aim of influencing the behaviour of people without direct economic incentives.

We firmly believe that providing expert feedback can be a viable option in clinical practice to help address the problem of excessive antibiotic use by simple means. The experiment also shows that individual characteristics – such as the willingness to take risks – or the experience of the physician influence prescribing decisions. Such findings suggest that individual characteristics should be taken into account when implementing measures to influence antibiotic prescribing practices.

Our study, led by Professor Daniel Wiesen, was part of the interdisciplinary UoC Forum ‘Managerial Risk Factors in Medicine’, initiated by Professor Ludwig Kuntz, and funded by the Excellence Initiative of the German federal and state governments ( Researchers from the Faculty of Management, Economics and Social Sciences and from the University of Cologne’s Faculty of Medicine were involved in the interdisciplinary study.



The Effect of Expert Feedback on Antibiotic Prescribing in Pediatrics: Experimental Evidence

(Kerstin Eilermann, Katrin Halstenberg, Ludwig Kuntz, Kyriakos Martakis, Bernhard Roth, Daniel Wiesen)

Medical Decision Making,