Providing Antibiotic Prescribing Feedback to Primary Care Physicians: The Ontario Program To Improve AntiMicrobial USE

NCT03776383 | Completed

• 1 other identifier: 2018-046.01
• Study Type: interventional
• Target: 3,500
• Locations: 1 country
• Sites: 1

Brief Summary

Antibiotic overuse occurs in multiple jurisdictions and is associated with rising rates of antimicrobial resistance. Mailing letters to the highest antibiotic prescribing physicians is a potentially effective method to optimize antibiotic use. The objectives of this study are to improve enrollment to Health Quality Ontario's Primary Care Practice report and reduce unnecessary antibiotic use. The investigators are conducting a randomized controlled trial recruiting the 3500 highest antibiotic prescribing primary care physicians in Ontario. The investigators have incorporated behavioural science theory into designing letters to modify prescribing behaviour. Letter 1 is testing change ideas related to antibiotic initiation and letter 2 is testing change ideas related to antibiotic duration. There will be 1500 physicians receiving letter 1, 1500 receiving letter 2, and 500 will serve as controls. Twelve months later all 3500 physicians will receive a letter.

Conditions

Antibiotic Prescribing Audit and Feedback

Keywords

Antibiotic use; Audit and feedback; implementation science; Antimicrobial stewardship

Outcome Measures

Primary Outcomes (2)

• Antibiotic prescribing rate

  Number of antibiotics prescribed per 100 total prescriptions

  12 months

• Prolonged duration prescribing rate

  Proportion of antibiotic prescriptions that are \>7 days per 100 total prescriptions

  12 months

Secondary Outcomes (1)

• New enrollment for Health Quality Ontario primary care practice reports

  24 months

Other Outcomes (10)

• New enrollment for Health Quality Ontario primary care practice reports

  6 months

• New enrollment for Health Quality Ontario primary care practice reports

  12 months

• Antibiotic prescribing rate

  3 months

Study Arms (3)

Antibiotic use feedback letter 1

ACTIVE COMPARATOR

Antibiotic use feedback letter 1 provides physicians with information on their antibiotic use plus change ideas on appropriate antibiotic prescribing for acute respiratory conditions

Other: Antibiotic use feedback letter

Antibiotic use feedback letter 2

ACTIVE COMPARATOR

Antibiotic use feedback letter 2 provides physicians with information on their antibiotic use plus change ideas on appropriate antibiotic durations for common infections

Other: Antibiotic use feedback letter

Control

NO INTERVENTION

Controls will not receive a letter

Interventions

Antibiotic use feedback letter OTHER

Mailed letters indicating that the physician prescribes more antibiotics than 75% of their peers

Antibiotic use feedback letter 1; Antibiotic use feedback letter 2

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Ontario primary care physicians
• Prescribe more antibiotics by volume than 75% of Ontario primary care physicians
• A College of Physicians and Surgeons of Ontario number in 2017-2018

You may not qualify if:

• None

Sponsors & Collaborators

• Ontario Agency for Health Protection and Promotion: lead
• Canadian Institutes of Health Research (CIHR): collaborator
• Health Quality Ontario: collaborator

Study Sites (1)

Public Health Ontario

Toronto, Ontario, M5G 1V2, Canada

Location

Related Publications (8)

• Hallsworth M, Chadborn T, Sallis A, Sanders M, Berry D, Greaves F, Clements L, Davies SC. Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomised controlled trial. Lancet. 2016 Apr 23;387(10029):1743-52. doi: 10.1016/S0140-6736(16)00215-4. Epub 2016 Feb 18.

  PMID: 26898856 BACKGROUND

• Hemkens LG, Saccilotto R, Reyes SL, Glinz D, Zumbrunn T, Grolimund O, Gloy V, Raatz H, Widmer A, Zeller A, Bucher HC. Personalized prescription feedback to reduce antibiotic overuse in primary care: rationale and design of a nationwide pragmatic randomized trial. BMC Infect Dis. 2016 Aug 17;16:421. doi: 10.1186/s12879-016-1739-0.

  PMID: 27530528 BACKGROUND

• Nudge vs Superbugs: A behavioural economics trial to reduce the overprescribing of antibiotics, Available online at: http://behaviouraleconomics.pmc.gov.au/sites/default/files/projects/report-nudge-vs-superbugs.pdf (accessed June 27, 2018).

  BACKGROUND

• McCullough AR, Rathbone J, Parekh S, Hoffmann TC, Del Mar CB. Not in my backyard: a systematic review of clinicians' knowledge and beliefs about antibiotic resistance. J Antimicrob Chemother. 2015 Sep;70(9):2465-73. doi: 10.1093/jac/dkv164. Epub 2015 Jun 20.

  PMID: 26093375 BACKGROUND

• Eccles MP, Grimshaw JM, Johnston M, Steen N, Pitts NB, Thomas R, Glidewell E, Maclennan G, Bonetti D, Walker A. Applying psychological theories to evidence-based clinical practice: identifying factors predictive of managing upper respiratory tract infections without antibiotics. Implement Sci. 2007 Aug 3;2:26. doi: 10.1186/1748-5908-2-26.

  PMID: 17683558 BACKGROUND

• Hrisos S, Eccles M, Johnston M, Francis J, Kaner EF, Steen N, Grimshaw J. Developing the content of two behavioural interventions: using theory-based interventions to promote GP management of upper respiratory tract infection without prescribing antibiotics #1. BMC Health Serv Res. 2008 Jan 14;8:11. doi: 10.1186/1472-6963-8-11.

  PMID: 18194527 BACKGROUND

• Pennell ML, Hade EM, Murray DM, Rhoda DA. Cutoff designs for community-based intervention studies. Stat Med. 2011 Jul 10;30(15):1865-82. doi: 10.1002/sim.4237. Epub 2011 Apr 17.

  PMID: 21500240 BACKGROUND

• Schwartz KL, Ivers N, Langford BJ, Taljaard M, Neish D, Brown KA, Leung V, Daneman N, Alloo J, Silverman M, Shing E, Grimshaw JM, Leis JA, Wu JHC, Garber G. Effect of Antibiotic-Prescribing Feedback to High-Volume Primary Care Physicians on Number of Antibiotic Prescriptions: A Randomized Clinical Trial. JAMA Intern Med. 2021 Sep 1;181(9):1165-1173. doi: 10.1001/jamainternmed.2021.2790.

  PMID: 34228086 DERIVED

Study Officials

• Kevin Schwartz, MD MSc

  Ontario Agency for Health Protection and Promotion

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: The data for the outcome are being provided from a third party with no involvement in the study
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: PI

Model Details: 3:3:1 for intervention 1: intervention 2: control

Study Record Dates

• First Submitted: December 12, 2018
• First Posted: December 14, 2018
• Study Start: December 14, 2018
• Primary Completion: November 30, 2019
• Study Completion: November 30, 2020
• Last Updated: March 3, 2021

Record last verified: 2021-03

Data Sharing

• IPD Sharing: Will not share

Locations

CA (1)