Improving Safe Antibiotic Prescribing in Telehealth
1 other identifier
interventional
6,581
1 country
1
Brief Summary
Appropriate use of antibiotics reduces resistance and protects patients from unnecessary harm. Important advances in antibiotic stewardship have been achieved in outpatient settings, but little is known about stewardship in the rapidly growing telehealth sector. Prior pragmatic randomized trials have shown that Centers for Disease Control (CDC) Core Element interventions constructed using insights from decision and social psychology can greatly reduce inappropriate prescribing in outpatient settings. In a randomized trial, the investigators will adapt and test two aspects of CDC Core Elements in a telehealth environment (Teladoc®), each with two levels of intensity. Teladoc® clinicians will be randomized to the following interventions: 1) Performance Feedback (Trending, Benchmark Peer Comparison), 2) Commitment (Private, Public), or 3) Control. All randomization occurs at the provider level, with the exception of the Public Commitment arm, which requires patient-facing content that is determined by patient state. Clinicians and members will see the same messages across all pages, all channels \& all consults during the 12-month study period. The primary outcome is to assess change in antibiotic prescribing rate for qualifying acute respiratory infection visits (ARIs).
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for not_applicable
Started Mar 2022
1 active site
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
Click on a node to explore related trials.
Study Timeline
Key milestones and dates
First Submitted
Initial submission to the registry
October 20, 2021
CompletedFirst Posted
Study publicly available on registry
December 1, 2021
CompletedStudy Start
First participant enrolled
March 3, 2022
CompletedPrimary Completion
Last participant's last visit for primary outcome
March 21, 2023
CompletedStudy Completion
Last participant's last visit for all outcomes
September 21, 2023
CompletedJanuary 18, 2024
January 1, 2024
1 year
October 20, 2021
January 17, 2024
Conditions
Keywords
Outcome Measures
Primary Outcomes (1)
Change in antibiotic prescribing rate for Acute Respiratory Infections
Change in antibiotic prescribing rate for acute respiratory infection visits based on the International Statistical Classification of Diseases, version 10 (ICD-10) codes including: non-specific upper respiratory infections, otitis media, sinusitis, pharyngitis, bronchitis, influenza, and COVID-19.
12 months
Secondary Outcomes (1)
Change in inappropriate antibiotic prescribing rate for Acute Respiratory Infections
12 months
Study Arms (9)
Trending Feedback + Private Commitment
EXPERIMENTALClinicians receive both Trending Feedback + Private Commitment interventions.
Trending Feedback + Public Commitment
EXPERIMENTALClinicians receive both Trending Feedback + Public Commitment interventions.
Trending Feedback + Commitment Control
EXPERIMENTALClinicians receive Trending Feedback intervention + Commitment Control.
Benchmark Peer Comparison Feedback + Private Commitment
EXPERIMENTALClinicians receive both Benchmark Peer Comparison Feedback + Private Commitment interventions.
Benchmark Peer Comparison Feedback + Public Commitment
EXPERIMENTALClinicians receive both Benchmark Peer Comparison Feedback + Public Commitment interventions.
Benchmark Peer Comparison Feedback + Commitment Control
EXPERIMENTALClinicians receive Benchmark Peer Comparison Feedback intervention + Commitment Control.
Public Commitment + Feedback Control
EXPERIMENTALClinicians receive Public Commitment intervention + Feedback Control.
Private Commitment + Feedback Control
EXPERIMENTALClinicians receive Private Commitment intervention + Feedback Control.
Commitment Control + Feedback Control
NO INTERVENTIONClinicians receive no intervention.
Interventions
Clinicians randomized to Trending Feedback will receive monthly feedback on the provider dashboard page.
Clinicians randomized to Benchmark Peer Comparison Feedback will receive monthly feedback on the provider dashboard page.
Clinicians assigned to the Private Commitment will be prompted in the provider dashboard to make a personal commitment to evidence-based use of antibiotics that will not be shared with their patients.
Clinicians assigned to Public Commitment will be prompted in the provider dashboard to make a commitment to evidence-based use of antibiotics that will be shared with their patients.
Eligibility Criteria
You may qualify if:
- Clinicians with prescribing privileges and one or more Acute Respiratory Infection visit
- Eligible encounters include pediatric and adult telehealth visits for Acute Respiratory Infections, including Sinusitis, Bronchitis, Influenza, Otitis Media, Nasopharyngitis, Upper Respiratory Infections, and COVID-19.
Contact the study team to confirm eligibility.
Sponsors & Collaborators
- University of Southern Californialead
- Agency for Healthcare Research and Quality (AHRQ)collaborator
- Teladoc Healthcollaborator
Study Sites (1)
Teladoc Health
Dallas, Texas, 75244, United States
Related Publications (6)
Chua KP, Fischer MA, Linder JA. Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study. BMJ. 2019 Jan 16;364:k5092. doi: 10.1136/bmj.k5092.
PMID: 30651273BACKGROUNDMeeker D, Knight TK, Friedberg MW, Linder JA, Goldstein NJ, Fox CR, Rothfeld A, Diaz G, Doctor JN. Nudging guideline-concordant antibiotic prescribing: a randomized clinical trial. JAMA Intern Med. 2014 Mar;174(3):425-31. doi: 10.1001/jamainternmed.2013.14191.
PMID: 24474434BACKGROUNDMeeker D, Linder JA, Fox CR, Friedberg MW, Persell SD, Goldstein NJ, Knight TK, Hay JW, Doctor JN. Effect of Behavioral Interventions on Inappropriate Antibiotic Prescribing Among Primary Care Practices: A Randomized Clinical Trial. JAMA. 2016 Feb 9;315(6):562-70. doi: 10.1001/jama.2016.0275.
PMID: 26864410BACKGROUNDSanchez GV, Fleming-Dutra KE, Roberts RM, Hicks LA. Core Elements of Outpatient Antibiotic Stewardship. MMWR Recomm Rep. 2016 Nov 11;65(6):1-12. doi: 10.15585/mmwr.rr6506a1.
PMID: 27832047BACKGROUNDLinder JA, Meeker D, Fox CR, Friedberg MW, Persell SD, Goldstein NJ, Doctor JN. Effects of Behavioral Interventions on Inappropriate Antibiotic Prescribing in Primary Care 12 Months After Stopping Interventions. JAMA. 2017 Oct 10;318(14):1391-1392. doi: 10.1001/jama.2017.11152.
PMID: 29049577BACKGROUNDMcCabe BK, Linder JA, Doctor JN, Friedberg M, Fox CR, Goldstein NJ, Knight TK, Kaiser K, Tibbels J, Haenchen S, Persell SD, Warberg R, Meeker D. The protocol of improving safe antibiotic prescribing in telehealth: A randomized trial. Contemp Clin Trials. 2022 Aug;119:106834. doi: 10.1016/j.cct.2022.106834. Epub 2022 Jun 18.
PMID: 35724841DERIVED
Study Officials
- PRINCIPAL INVESTIGATOR
Daniella Meeker, PhD
University of Southern California
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- RANDOMIZED
- Masking
- DOUBLE
- Who Masked
- INVESTIGATOR, OUTCOMES ASSESSOR
- Masking Details
- Patients are blinded to all study arms with the exception of Public Commitment where, by design, patients are exposed to physicians' commitment. Physicians cannot be blinded to interventions that, by design, impact the electronic medical record display.
- Purpose
- HEALTH SERVICES RESEARCH
- Intervention Model
- FACTORIAL
- Sponsor Type
- OTHER
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- Associate Professor
Study Record Dates
First Submitted
October 20, 2021
First Posted
December 1, 2021
Study Start
March 3, 2022
Primary Completion
March 21, 2023
Study Completion
September 21, 2023
Last Updated
January 18, 2024
Record last verified: 2024-01