Clinical Trial Details
— Status: Completed
Administrative data
NCT number |
NCT03807466 |
Other study ID # |
441-2017 |
Secondary ID |
|
Status |
Completed |
Phase |
N/A
|
First received |
|
Last updated |
|
Start date |
May 15, 2017 |
Est. completion date |
March 31, 2021 |
Study information
Verified date |
August 2021 |
Source |
Institute for Clinical Evaluative Sciences |
Contact |
n/a |
Is FDA regulated |
No |
Health authority |
|
Study type |
Interventional
|
Clinical Trial Summary
There is a high rate of inappropriate antibiotic use in long-term care (LTC) facilities, with
both unnecessary initiation and prolongation of treatments. Although there are challenges to
rational antibiotic use in LTC, the variability in antibiotic initiation and use of prolonged
treatment durations is driven by prescriber tendencies rather than resident characteristics.
Audit-and-feedback is a well-established intervention to improve professional practices, and
is ideally suited for use to improve antibiotic prescribing tendencies in LTC. The literature
is saturated with trials indicating benefit of audit-and-feedback, but is in dire need of
studies to identify methods to improve the impact of this technique. Health Quality Ontario
(HQO), a key partner in the FIRST AID-LTC research program, is already providing
audit-and-feedback for other inappropriate prescribing practices in LTC, and has identified
antibiotic prescribing as a priority focus.
Description:
Overarching Goals
The overarching goals of FIRST AID - LTC are two-fold:
1. Improve rational antibiotic prescribing by physicians to minimize harms among LTC
residents.
2. Advance the science of audit-and-feedback to improve physician prescribing practices.
Specific Aims
To improve rational antibiotic prescribing in LTC:
1. by decreasing unnecessary initiation of antibiotic treatments among Ontario LTC
residents, as well as the variability in initiation rates across LTC prescribers.
2. by decreasing unnecessary prolonged duration of antibiotic treatments among Ontario LTC
residents, as well as the variability in prolonged duration treatment use across LTC
prescribers.
To advance audit-and-feedback implementation science:
1. by evaluating whether a dynamic audit-and-feedback report highlighting antibiotic
prescribing can lead to greater reductions in antibiotic use, than a static paginated report
Anticipated Contributions to Health-Related Knowledge
Although the literature is inundated with trials examining the impact of audit-and-feedback
compared to usual care, there is a need for studies to improve audit-and-feedback delivery.
FIRST AID-LTC will test optimal delivery and peer comparison techniques for
audit-and-feedback. The knowledge learned can be extrapolated to antibiotic interventions in
LTC in other provinces across Canada, as well more broadly to inappropriate medication
prescribing practices in LTC.
Anticipated Contributions to Health Care, Health Systems and Health Outcomes
FIRST AID-LTC will lead to immediate reductions in excess antibiotic use in Ontario LTC
facilities, which in turn should result in substantial reductions in direct drug costs, as
well as downstream complications of allergy, organ toxicity, C. difficile infections and
antimicrobial resistance. With easy transferability to other Canadian provinces, the
improvements in cost-savings and patient outcomes could be massive in scope.