British Columbia Prescriber Feedback Program - Antimicrobial Resistance

NCT07431190 | Not Yet Recruiting

• 1 other identifier: H26-00208
• Study Type: interventional
• Target: 7,626
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this study is to evaluate an educational intervention that aims to reduce the number of unnecessary antibiotics prescribed by family physicians and nurse practitioners in British Columbia, Canada. The intervention materials include a confidential personalized prescribing "portrait" and an evidence-based educational summary (therapeutics letter), accompanied by an introduction letter. The main research questions are:

1. 1.Will the intervention lead to a reduction in the overall number of antibiotics prescriptions started?
2. 2.Will the intervention lead to a reduction in the proportion of antibiotics prescribed that are likely unnecessary, especially prescriptions for upper respiratory tract infections, acute bronchitis, acute sinusitis?

Conditions

Quality Improvement; Feedback; Prescribing; Antibiotics; Antimicrobial Drug Resistance

Keywords

Randomized controlled trial; Prescribing feedback; Quality improvement; Antibiotics; Antimicrobial resistance

Outcome Measures

Primary Outcomes (1)

• Weekly rate of incident oral antibiotic prescribing

  The primary outcome is the number of incident oral antibiotic prescriptions per practitioner per week. Follow-up time will be calculated for each practitioner in the 52 weeks before and 39 weeks after the portrait is mailed to the Early group. A practitioner will count as contributing a full week (7 days) of follow-up if, during that week, they either: 1) wrote at least one prescription (recorded in PharmaNet), or 2) billed the Medical Services Plan for at least one patient visit. Weekly prescribing rates will be plotted by Early and Delayed groups and analyzed using Poisson regression with generalized estimating equations to account for repeated measures. Models will adjust for cohort (Early vs. Delay), age, sex, rural practice, and provider type. The intervention effect will be estimated using a pre-post level-change variable and its interaction with cohort status, representing the adjusted mean impact of the portrait.

  From trial initiation to 30 days, 3, 6, and 9 months post-intervention

Secondary Outcomes (2)

• Weekly rate of 'likely unnecessary' antibiotic prescriptions

  From trial initiation to 30 days, 3, 6, and 9 months post-intervention

• Weekly rate of 'likely unnecessary' condition-specific antibiotic prescriptions

  From trial initiation to 30 days, 3, 6, and 9 months post-intervention

Study Arms (2)

Early Group - Prescribing portrait audit and feedback

EXPERIMENTAL

The Early Group of clinicians (n=6100) will be mailed the prescribing portrait audit-and-feedback intervention (prescribing portrait, evidence summary, and introduction letter) at the study initiation in February 2026.

Behavioral: Prescribing portrait audit and feedback

Delayed control - Prescribing portrait audit-and-feedback

EXPERIMENTAL

Delayed control group (n=1526) of clinicians will be mailed the audit-and-feedback intervention (prescribing portrait, evidence summary, and introduction letter) approximately 9 months after Group 1 (Early Group).

Behavioral: Prescribing portrait audit and feedback

Interventions

Prescribing portrait audit and feedback BEHAVIORAL

The prescribing portrait audit-and-feedback intervention consists of a confidential, personalized prescribing audit-and-feedback report (Portrait), an evidence-based educational summary (therapeutics letter), and an introduction letter. The prescribing portrait uses linked BC Ministry of Health administrative claims data and presents two key recommendations: (1) reduce the proportion of patient visits resulting in an antibiotic prescription, and (2) avoid routinely prescribing antibiotics for upper respiratory tract infections, acute bronchitis, and acute sinusitis. Each recommendation is accompanied by a bar graph showing the prescriber's 2024 performance compared with the median prescriber in British Columbia and an achievable target. The intervention will be delivered using a secure paper mailing process. During every aspect of production and delivery, prescribing data are confidential and protected.

Delayed control - Prescribing portrait audit-and-feedback; Early Group - Prescribing portrait audit and feedback

Eligibility Criteria

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

You may qualify if:

• Registered in 2024 with the BC Medical Services Plan (MSP) with:
• A valid MSP billing number;
• Status of Salaried, Private Practice, Temporary Licence, or Post Graduate;
• Prescribed \>100 dispensed medications in 2024.

You may not qualify if:

• Previously opted out of the Therapeutics Initiative Portrait program
• Age \<18 years at time of oral antibiotic dispensation;
• Received PharmaCare benefits through the Palliative Care program at any time during the baseline or study period;
• Hospitalized within 1 week prior to an antibiotic prescription at any time during the baseline or study period;
• On chronic suppressive antibiotic therapy (≥90 days' supply of any antibiotic dispensed) during the baseline or study period

Sponsors & Collaborators

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

Central Study Contacts

Ellen Reynolds, MPA

CONTACT

1-250-590-5955; ellen.reynolds@ubc.ca

Dana Stanley, MET

CONTACT

1-250-590-5955; dana.stanley@ubc.ca

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Masking Details: Participants will not be masked to their group allocation but will not be aware of the analytical approach. The statistical analysis plan is being developed by an evaluation committee who are masked to the trial arm allocation.
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SEQUENTIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Model Details: Investigators randomized actively practicing family physicians and nurse practitioners into two groups: Group 1 (n=6100) will receive the intervention at the start of the trial and Group 2 (n=1526) will serve as a delayed control and will receive the same intervention approximately 9 months after Group 1.

Study Record Dates

• First Submitted: February 17, 2026
• First Posted: February 24, 2026
• Study Start: February 17, 2026
• Primary Completion (Estimated): November 30, 2026
• Study Completion (Estimated): November 30, 2028
• Last Updated: February 24, 2026

Record last verified: 2026-02

Data Sharing

• IPD Sharing: Will not share

Locations

CA (1)