It's too bad there were no behavioral scientists at the recent Interscience Conference on Antimicrobial Agents and Chemotherapy in New Orleans. They would have been delighted by the divergent results of four attempts to alter physician antibiotic prescribing practices. The four programs comprise a casebook of how and how not to go about altering behavior.
If you set guidelines but communicate them only by mail, you probably will not accomplish much, a study in Utah showed. In this effort, the Utah Professional Standards Review Organization (PSRO) sent all physicians in the state a booklet outlining appropriate prophylactic use of antibiotics in surgery. The publication defined operations in which such usage was not indicated—so-called clean operations—and recommended that in other operations antibiotic prophylaxis be started less than six hours before the procedure and continued for no more than 48 hours afterward.
Both before and after the booklet was sent out, prescribing