Evaluation of an Educational Intervention on Antibiotics in Dental Care

NCT07016217 | Active Not Recruiting

• 1 other identifier: H23-01507
• Study Type: interventional
• Target: 3,498
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this randomized trial is to estimate the impact of personalized prescribing portraits and educational materials on prescribing of antibiotic medications by dentists in British Columbia, Canada. The main research question is: Did the prescribing Portraits and Therapeutics Letter lead to a change in clindamycin prescribing as a proportion of total antibiotic prescribing by dentists in British Columbia. Study participants are dentists actively practicing in British Columbia. Participants were randomized to 3 study arms to received different combinations of one of two versions of the individual prescribing Portraits and a Therapeutics Letter in Early or Delayed Groups. Two versions of the prescribing Portrait were used: a "plain" version and a "complete" version, which included an additional section with self-reflection questions for clinicians. Using administrative health data, the prescribing of those in different combinations of materials in the Early Group will be compared to those in the Delayed Group to estimate the impact of the materials on prescribing by the dentists.

Conditions

Dental Infection; Clindamycin; Antibiotics

Keywords

randomized controlled trial; dental infection; clindamycin; quality improvement; prescribing feedback; antibiotics

Outcome Measures

Primary Outcomes (1)

• Intention to treat analysis

  The primary outcome is the change in clindamycin prescribing (number of new starts) as a proportion of total antibiotic prescribing associated with the interventions.

  Assessed from the baseline until the early intervention (6 months) to 6 months after the delayed intervention (total of 18 months).

Study Arms (3)

Arm A (Group 1) - Portrait + Letter

EXPERIMENTAL

This group received the "plain" Portrait with a Therapeutics Letter in the Early mailing (Oct 13, 2023), and received the "complete" Portrait with a Therapeutics Letter in the Delayed mailing (April 24, 2024).

Behavioral: Early Plain Portrait and Letter; Behavioral: Delayed Complete Portrait

Arm B (Group 2) - Portrait + Letter

EXPERIMENTAL

This group received the "complete" Portrait with a Therapeutics Letter in the Early mailing (Oct 13, 2023), and received nothing in the Delayed mailing (April 24, 2024).

Behavioral: Early Complete Portrait and Letter; Behavioral: No intervention

Arm C (Group 3) - Control

EXPERIMENTAL

This group received nothing in the Early mailing (Oct 13, 2023) and received the "plain" Portrait with a Therapeutics Letter in the Delayed mailing (April 24, 2024).

Behavioral: No intervention; Behavioral: Delayed Plain Portrait and Letter

Interventions

Early Plain Portrait and Letter BEHAVIORAL

In the context of audit and feedback interventions, the prescribing Portrait is a document produced by the Therapeutics Initiative that provides personalized prescribing feedback for clinicians in British Columbia. Portraits are used as a practice resource tool for reflection on prescribing or test-ordering patterns. The Portraits provide data of individual prescribing along with evidence-based benchmarks or targets. The "plain" Portrait includes the main message, prescriber's data (compare to optimal prescribing, with or without information on BC mean/median). Prescribers are also given access to a succinct review of the best available evidence on the topic and recommendations for future action in the Therapeutics Letter, a standalone publication that details the evidence for the recommended practice in a brief and practical manner, with references.

Arm A (Group 1) - Portrait + Letter

Early Complete Portrait and Letter BEHAVIORAL

In the context of audit and feedback interventions, the prescribing Portrait is a document produced by the Therapeutics Initiative that provides personalized prescribing feedback for clinicians in British Columbia. Portraits are used as a practice resource tool for reflection on prescribing or test-ordering patterns. The Portraits provide data of individual prescribing along with evidence-based benchmarks or targets. The "complete" Portrait includes the main message, prescriber's data (compare to optimal prescribing, with or without information on BC mean/median) and a series of self-reflection questions. Prescribers are also given access to a succinct review of the best available evidence on the topic and recommendations for future action in the Therapeutics Letter, a standalone publication that details the evidence for the recommended practice in a brief and practical manner, with references.

Arm B (Group 2) - Portrait + Letter

No intervention BEHAVIORAL

To measure the impact of the interventions, Arm C (Group 3) will receive no intervention in the Early mailing and Arm B (Group 2) will receive no intervention in the Delayed mailing.

Arm B (Group 2) - Portrait + Letter; Arm C (Group 3) - Control

Delayed Plain Portrait and Letter BEHAVIORAL

Delayed "plain" Portrait and Letter (as described)

Arm C (Group 3) - Control

Delayed Complete Portrait BEHAVIORAL

Delayed "complete" Portrait and Letter (as described)

Arm A (Group 1) - Portrait + Letter

Eligibility Criteria

• Age: 16 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Dentists registered with the BC College of Oral Health Professionals with an active dental practice in BC
• Dentists in BC included in randomization groups 1-3 with at least 10 prescription orders filled for antibiotics in 2022
• Patients aged \>16
• Patient prescribed antibiotic therapy by a BC dentist during, before, or after periods; Anatomical Therapeutic Chemical (ATC) classes J01
• Patient was enrolled in MSP at least 1 month before the prescription

You may not qualify if:

• Dentists not registered with the BC College of Oral Health Professionals
• Dentists with fewer than 10 prescription orders filled in 2022
• Patients used antibiotics in the last 14 days (prescribed by any prescriber, not only dentists) before the prescription; and
• Federally insured BC residents and beneficiaries of the First Nations Health Benefit Plan; we were not given permission to use these data in our evaluation

Sponsors & Collaborators

• University of British Columbia: lead
• Ministry of Health, British Columbia: collaborator
• British Columbia Centre for Disease Control: collaborator
• British Columbia College of Oral Health Professionals: collaborator

Study Sites (1)

Therapeutics Initiative - Dept of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia

Vancouver, British Columbia, V6T 1Z3, Canada

Location

Study Officials

• Colin Dormuth, ScD

  University of British Columbia

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SEQUENTIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Model Details: The investigators randomized actively practicing dentists into three groups, n=1166 in each group for a total of 3498 individual dentists. For the Early mailing on Oct 13, 2023, Arm A/Group 1 received the "plain" Portrait with a Therapeutics Letter; Arm B/Group 2 received a "complete" Portrait with a Letter, and Arm C/ Group 3 received nothing (control group). For the delayed mailing (April 24, 2024), Arm A/Group 1 received the "complete" Portrait and Letter, Arm B/Group 2 received nothing, and Arm C/ Group 3 received the "plain" Portrait and Letter.

Study Record Dates

• First Submitted: June 3, 2025
• First Posted: June 11, 2025
• Study Start: May 15, 2023
• Primary Completion: October 24, 2024
• Study Completion (Estimated): May 15, 2027
• Last Updated: June 11, 2025

Record last verified: 2025-06

Data Sharing

• IPD Sharing: Will not share

Locations

CA (1)