This study examines whether an antimicrobial stewardship approach grounded in behavioral theory and focusing on preserving prescriber autonomy and participation is associated with appropriateness of antimicrobial prescribing in hospitals. In this multicenter intervention study examining 1121 patient cases with 700 antimicrobial prescriptions during the baseline period and 882 patient cases with 531 antimicrobial prescriptions during the intervention period, appropriateness of antimicrobial prescribing significantly increased by 13.3% during a follow-up period of 12 months after intervention start.

Use of a behavioral approach preserving prescriber autonomy resulted in an increase in antimicrobial appropriateness sustained for at least 12 months. The approach is inexpensive and could be easily transferable to various health care environments.

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