Does Inclusion of Viral Prescription Pad Resources Increase Responsiveness to Feedback About Antibiotic Prescribing in Primary Care

NCT05044052 | Completed

• 1 other identifier: 2020-0024-E (OH Trial)
• Study Type: interventional
• Target: 3,379
• Locations: 1 country
• Sites: 1

Brief Summary

Antibiotic overuse is common and antibiotic prescribing contributes to rising rates of antimicrobial resistance. Primary care physicians prescribe the majority of all antibiotics and there is large inter-physician variability in prescribing that cannot be explained by differences in patient populations. In Ontario, audit and feedback (A\&F) is routinely offered to primary care providers from a variety of sources. Ontario Health - an agency created by the Government of Ontario - provides A\&F via email to physicians who voluntarily sign up for their "MyPractice" reports. These are multi-topic reports with aggregated (physician-level) data. As of November 2021, the MyPractice reports for family physicians will include data on antibiotic prescribing. To date, less than half of Ontario family physicians have signed up for the MyPractice reports from Ontario Health. For this study, the investigators will conduct a trial to investigate the effect of adding viral prescription pad resources to family physician A\&F received through a MyPractice: Primary Care report. This evaluation provides an opportunity to determine if the addition of this resource to an A\&F intervention increases changes to antibiotic prescribing.

Conditions

Infection

Keywords

audit and feedback; antibiotics

Outcome Measures

Primary Outcomes (1)

• Antibiotic prescribing rate

  Total number of antibiotic prescriptions per 1000 65+ patient visits

  6 months

Secondary Outcomes (10)

• Proportion Antibiotic Rx with Prolonged Duration

  6 months

• Proportion Antibiotic Rx with Prolonged Duration

  12 months

• Antibiotic drug costs

  6 months

• Antibiotic drug costs

  12 months

• Antibiotics prescribed for viral infections

  6 months

Study Arms (2)

Intervention Group - Viral prescription pad + emphasis

EXPERIMENTAL

Physicians in this group will receive their usual MyPractice: Primary Care report from Ontario Health. This report will include antibiotic prescribing indicators as well as a link to the viral prescription pad. As part of the intervention, these physicians will also receive additional emphasis on the viral prescription pad by 1) encouraging it in the dissemination email of the MyPractice feedback report, and (2) mailing a paper version of the viral prescription pad with instructions on embedding the viral prescription pad into the recipient's EMR.

Behavioral: Emphasis on the Choosing Wisely Viral Prescription Pad

Control group

NO INTERVENTION

Physicians in this group will receive their usual MyPractice: Primary Care report from Ontario Health. This report will include antibiotic prescribing indicators as well as a link to the viral prescription pad. This group will not receive any additional emphasis on the viral prescription pad and will not receive a paper copy in the mail.

Interventions

Emphasis on the Choosing Wisely Viral Prescription Pad BEHAVIORAL

We will investigate the effects of emphasizing the use of materials developed by Choosing Wisely Canada (CWC) - namely the viral prescription pad - to help physicians act upon the feedback to reduce their prescribing.

Intervention Group - Viral prescription pad + emphasis

Eligibility Criteria

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

You may qualify if:

• Family physicians who sign up for the MyPractice reports by September 2021

You may not qualify if:

• Family physicians who did not sign up for the MyPractice reports by September 2021

Sponsors & Collaborators

• Women's College Hospital: lead
• Ontario Agency for Health Protection and Promotion: collaborator
• College of Family Physicians of Canada: collaborator
• Canadian Institutes of Health Research (CIHR): collaborator

Study Sites (1)

Women's College Hospital

Toronto, Ontario, M5G 1N8, Canada

Location

Related Publications (2)

• Shuldiner J, Lacroix M, Saragosa M, Reis C, Schwartz KL, Gushue S, Leung V, Grimshaw J, Silverman M, Thavorn K, Leis JA, Kidd M, Daneman N, Tradous M, Langford B, Morris AM, Lam J, Garber G, Brehaut J, Taljaard M, Greiver M, Ivers NM. Process evaluation of two large randomized controlled trials to understand factors influencing family physicians' use of antibiotic audit and feedback reports. Implement Sci. 2024 Sep 16;19(1):65. doi: 10.1186/s13012-024-01393-5.

  PMID: 39285305 DERIVED

• Shuldiner J, Schwartz KL, Langford BJ, Ivers NM; Ontario Healthcare Implementation Laboratory study team. Optimizing responsiveness to feedback about antibiotic prescribing in primary care: protocol for two interrelated randomized implementation trials with embedded process evaluations. Implement Sci. 2022 Feb 14;17(1):17. doi: 10.1186/s13012-022-01194-8.

  PMID: 35164805 DERIVED

MeSH Terms

Conditions

Infections

Study Officials

• Noah M Ivers, MD

  Women's College Hospital

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Family Physician, Canada Research Chair (Tier 2) in Implementation of Evidence Based Practice

Model Details: Cluster Randomized Control Trial

Study Record Dates

• First Submitted: September 3, 2021
• First Posted: September 14, 2021
• Study Start: December 15, 2021
• Primary Completion: June 15, 2022
• Study Completion: December 15, 2022
• Last Updated: January 5, 2023

Record last verified: 2023-01

Data Sharing

• IPD Sharing: Will not share

Locations

CA (1)