TOPLINE:

A multifaceted initiative comprising an online educational course with monthly personalized feedback significantly reduced inappropriate corticosteroid injection use for acute respiratory tract infections (ARTIs) compared with no education among primary care clinicians identified as high corticosteroid utilizers. The intervention group showed a marked decrease in steroid use by the second month, and this reduction persisted through the sixth month.

METHODOLOGY:

• Researchers conducted a randomized controlled trial across 53 primary care clinics in southeast Louisiana, involving clinicians identified as high corticosteroid utilizers to reduce the inappropriate use of corticosteroids for ARTIs.
• Participants were physicians and advanced practice providers from primary care clinics with a baseline annual steroid injection rate of 5% or more for adult patients with ARTIs, including influenza, pneumonia, acute pharyngitis or sinusitis, acute upper RTIs, and allergic rhinitis.
• Clinics were randomly assigned to either the control group, where clinicians (n = 61; mean age, 46.2 years; 60.7% women) received no education, or the intervention group, where clinicians (n = 75; mean age, 42.9 years; 65.3% women) received a 1-hour online course with educational content covering appropriate use of corticosteroids, potential complications, and strategies for discussing steroid use with patients, along with monthly personalized feedback on steroid use.
• The primary outcome was the rate of corticosteroid injection use for ARTIs, measured every month over a 6-month period and compared between the two groups.
• Possible harms among the clinicians, such as fatigue or burnout, related to the intervention were also assessed.

TAKEAWAY:

• The intervention vs control group saw a reduction in injection steroid use, at 5.5 vs 10.7 per 100 patients (P = .03).
• By the second month, injection steroid use among intervention clinicians fell to less than 6% and remained lower than that in the control group throughout the study (P = .02).
• The intervention group vs control group showed a lower average rate of oral steroid use (7.6 vs 12.2 per 100 patients; P = .02).
• An 8% increase in-office visit utilization 30 days post-index visit was noted among patients seen by intervention clinicians vs control clinicians (P = .02). The response rate for assessing clinicians’ views of the intervention was low.

IN PRACTICE:

“Our work helps lay the groundwork to advance adopting inappropriate corticosteroid use as a primary care and ARTI care quality metric,” the authors wrote. “[The] novel intervention can be easily adopted by other specialties and health systems,” they added.

SOURCE:

This study was led by Evan L. Dvorin, MD, Primary Care and Wellness, Ochsner Health in New Orleans. It was published online on October 29, 2025, in the Journal of General Internal Medicine.

LIMITATIONS:

The study excluded patients with asthma and chronic obstructive pulmonary disease and assumed that all corticosteroid use in ARTI encounters was inappropriate, which may not always be the case. The change in prescribing behavior might have been limited to a subset of clinicians and not generalized across all participants.

DISCLOSURES:

The study did not receive any specific funding. The authors declared having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.