Do Clinicians Have Patience? Examining Delay Discounting, Perceived Stress, and Low-Value Antibiotic Prescribing

Abstract

Antimicrobial resistance has been deemed one of the top global threats by the World Health Organization, and the overuse of antibiotic medications contributes to antimicrobial resistance. Yet low-value antibiotic prescribing (LVAP; the prescription of antibiotics when not clinically indicated) is still widely prevalent across multiple healthcare disciplines, often for viral illnesses such as acute bronchitis. Behavioral factors such as delay discounting (DD; the extent to which someone prefers smaller, sooner rewards over larger, delayed rewards) and perceived stress may independently and interactively contribute to clinicians' high rates of LVAP. Examining how DD and perceived stress levels are related to each other and LVAP can help develop interventions to improve prescribing rates and promote high-quality patient care. In study one, we compared DD and probability discounting (PD; the extent to which someone prefers smaller, guaranteed rewards over larger, risky rewards) between cross-sectional survey samples of primary care clinicians and non-healthcare workers, finding that clinicians had lower DD and higher PD rates compared to non-healthcare workers. In study two, we analyzed data from the survey of non-healthcare workers to determine whether there was a significant relationship between DD, PD, and perceived stress levels, finding that both DD and PD were associated with perceived stress. In study three, we examined the associations between DD, perceived stress, and LVAP in a sample of clinicians from multiple departments across a large healthcare system. This included both self-reported likelihood of LVAP based on two clinical vignettes in a cross-sectional survey, as well as electronic health record-based incidence rates within 12 months prior to survey administration, and we found that DD was associated with self-reported LVAP likelihood in both clinical scenarios assessed. Ultimately, these three studies suggest that DD may be an important behavioral marker that warrants further investigation in the context of LVAP, a complex and recurring issue in healthcare. Future studies investigating the connection between LVAP and behavioral factors such as discounting and stress should seek to examine workplace-specific stress levels and further explore possibilities for interventions involving DD as a behavioral marker.