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

Infection Clinical Trial

Official title:

Do Peer-comparisons, Emphasis on Harms, and/or Inclusion of Viral Prescription Pad Resources Increase Responsiveness to Feedback About Antibiotic Prescribing in Primary Care: Protocol for Two Linked Trials With Embedded Process Evaluations (OH Trial)

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT05044052
• Other study ID #: 2020-0024-E (OH Trial)
• Status: Completed
• Phase: N/A
• Start date: December 15, 2021
• Est. completion date: December 15, 2022

Study information

• Verified date: January 2023
• Source: Women's College Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial 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.

Description:

This study will examine ways to optimize the effects of A&F for antibiotic prescribing in primary care. This study will aim to determine if emphasis (or not) on the use of a viral prescription pad developed by Choosing Wisely Canada (CWC) can help physicians act upon the feedback from their MyPractice report to reduce their antibiotic prescribing.

Antibiotic prescribing feedback within the multi-topic MyPractice: Primary Care report will be sent to family physicians who signed up for this program from Ontario Health. This report includes a link to the Choosing Wisely viral prescription pad. Physicians will be randomized to the control group or intervention group. Physicians in the intervention group will receive additional emphasis on the use of the viral prescription pad and will also have a paper copy of the prescription pad mailed to their practice.

One month after the initial intervention, participants will be invited to complete a process evaluation survey to determine why or why not the intervention worked and how individual factors can affect physician motivation, willingness, and ability to engage in new practices. Intervention participants will also be invited to take part in a process evaluation interview.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 3379
• Est. completion date: December 15, 2022
• Est. primary completion date: June 15, 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: N/A and older

Eligibility

Inclusion Criteria:

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

Exclusion Criteria:

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

Related Conditions & MeSH terms

• Infection

Intervention

Behavioral:
• Emphasis on the Choosing Wisely Viral Prescription Pad
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.

Locations

Country	Name	City	State
Canada	Women's College Hospital	Toronto	Ontario

Sponsors (4)

Lead Sponsor	Collaborator
Women's College Hospital	Canadian Institutes of Health Research (CIHR), College of Family Physicians of Canada, Ontario Agency for Health Protection and Promotion

Country where clinical trial is conducted

Canada, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Antibiotic prescribing rate	Total number of antibiotic prescriptions per 1000 65+ patient visits	6 months
Secondary	Proportion Antibiotic Rx with Prolonged Duration	Antibiotics prescribed for more than 7 days per episode	6 months
Secondary	Proportion Antibiotic Rx with Prolonged Duration	Antibiotics prescribed for more than 7 days per episode	12 months
Secondary	Antibiotic drug costs	Cost in CDN$	6 months
Secondary	Antibiotic drug costs	Cost in CDN$	12 months
Secondary	Antibiotics prescribed for viral infections	Total number of antibiotic rx per 1000 65+ patient visits for presumed viral condition (and thus likely unnecessary) based on administrative database diagnostic codes	6 months
Secondary	Antibiotics prescribed for viral infections	Total number of antibiotic rx per 1000 65+ patient visits for presumed viral condition (and thus likely unnecessary) based on administrative database diagnostic codes	12 months
Secondary	Total Antibiotic Days of Therapy	Total number DOTs per 1000 65+ patient visits	6 months
Secondary	Total Antibiotic Days of Therapy	Total number DOTs per 1000 65+ patient visits	12 months
Secondary	Proportion of broad spectrum antibiotic prescriptions	antibiotic prescriptions that are broad spectrum	6 months
Secondary	Proportion of broad spectrum antibiotic prescriptions	antibiotic prescriptions that are broad spectrum	12 months