A Multifaceted Intervention to Improve Prescribing for Acute Respiratory Infection for Adults and Children in Emergency Department and Urgent Care Settings

NCT03022929 | Completed DMC

• 2 other identifiers: 986083971471
• Study Type: interventional
• Target: 257
• Locations: 1 country
• Sites: 3

Brief Summary

Inappropriate antibiotic use is a major public health concern. Excessive exposure to antibiotics results in emergence and spread of drug-resistant bacteria, potentially avoidable adverse drug reactions, and increased healthcare utilization and cost. As antibiotic prescribing in emergency departments and urgent care centers remains unchecked, national professional organizations including the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology (SHEA), and an Executive Order from the President of the United States, recommend expansion of antimicrobial stewardship to these ambulatory care settings. The goal of antimicrobial stewardship is to effectively promote judicious antibiotic use in all healthcare settings, yet stewardship programs have not achieved their potential in terms of either reach or effectiveness. Reach has been limited by implementation mostly in inpatient settings; at the same time, recent critical experiments in behavioral science suggest that the effectiveness of existing stewardship programs could be greatly augmented through inclusion of behavioral nudges, benchmarked audit and feedback, and peer-to-peer comparisons.

Conditions

Respiratory Tract Infections

Outcome Measures

Primary Outcomes (1)

• Antibiotic Prescribing Trends

  The investigators will measure the likelihood that an antibiotic is prescribed in an antibiotic-nonresponsive acute respiratory infection visit.

  Up to 2 years

Study Arms (2)

Adapted Intervention

NO INTERVENTION

The investigators will use GetSmart materials published by the CDC appropriate to the emergency department and urgent care settings and select and adapt brochures and other campaign messages for acute care providers.

Enhanced Intervention

EXPERIMENTAL

The investigators will use all of the methods of the Adapted Intervention. In addition to these methods, the investigators will add posters within exam rooms which will include modified GetSmart content and other nudges such as physician pictures with their signed public commitment to antibiotic stewardship or flair denoting commitment to stewardship. The investigators will also provide physicians with personalized monthly performance ranking with each physician receiving the designation of "top performer" or "not a top performer" based on their appropriate antibiotic prescribing practices for acute respiratory infections. This will be the Enhanced Antimicrobial Stewardship Commitment and Feedback intervention.

Behavioral: Enhanced Antimicrobial Stewardship Commitment and Feedback

Interventions

Enhanced Antimicrobial Stewardship Commitment and Feedback BEHAVIORAL

Goes beyond the GetSmart recommendations to discern whether these recommendations can be improved upon.

Enhanced Intervention

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Must be a clinician at one of the study sites.
• Must treat adult and/or pediatric patients with an acute respiratory infections.

You may not qualify if:

• Medical co-morbidities that make acute respiratory infection (ARI) guidelines less likely to apply.
• Concomitant visit diagnoses indicating a non-ARI possible bacterial infection.
• Concomitant visit diagnoses indicating potentially antibiotic appropriate ARI. diagnoses or other ARI diagnoses suggestive of a bacterial infection.
• Visit occurred within 30 days of an earlier ARI diagnosis.

Sponsors & Collaborators

• University of California, Davis: lead

Study Sites (3)

UC Davis Medical Center

Sacramento, California, 95817, United States

Location

UCLA Harbor Medical Center

Torrance, California, 90509, United States

Location

Children's Hospital Colorado

Aurora, Colorado, 80045, United States

Location

MeSH Terms

Conditions

Respiratory Tract Infections

Condition Hierarchy (Ancestors)

Infections; Respiratory Tract Diseases

Study Officials

• Larissa S May, MD,MSPH,MSHS

  Associate Professor and Director of Emergency Department Antibiotic Stewardship

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: January 11, 2017
• First Posted: January 18, 2017
• Study Start: January 1, 2017
• Primary Completion: September 24, 2018
• Study Completion: September 24, 2018
• Last Updated: December 20, 2018

Record last verified: 2018-12

Data Sharing

• IPD Sharing: Will not share

Locations

US (3)