Please select the eligibility criteria that correspond to the clinical trial below.
Title: Ontario Healthcare Implementation Laboratory: A Learning Health System Approach That Leverages Data to Improve Quality in Primary Care: Stage 1
Brief Summary: Antibiotic overuse occurs in multiple jurisdictions and is associated with rising rates of antimicrobial resistance. Mailing letters to the highest antibiotic prescribing physicians is a potentially effective method to optimize antibiotic use. The objectives of this study are to improve enrollment to Health Quality Ontario's Primary Care Practice report and reduce unnecessary antibiotic use. The investigators are conducting a randomized controlled trial recruiting the 3500 highest antibiotic prescribing primary care physicians in Ontario. The investigators have incorporated behavioural science theory into designing letters to modify prescribing behaviour. Letter 1 is testing change ideas related to antibiotic initiation and letter 2 is testing change ideas related to antibiotic duration. There will be 1500 physicians receiving letter 1, 1500 receiving letter 2, and 500 will serve as controls. Twelve months later all 3500 physicians will receive a letter.


Options:
A: Inclusion Criteria:

* Patients, aged 6 to 65 years, that visit one of the 10 selected primary healthcare centers
* Suspected to have acute respiratory tract infection (ARI) by treating physician
* Informed consent

Exclusion Criteria:

* Severe respiratory disease as determined by treating doctor
* Any disease or symptom requiring hospital referral as determined by treating doctor
* Immunosuppressed patients (e.g. HIV, long term steroid use)
* Suspicion of tuberculosis
* Evidence of acute or chronic liver disease (e.g. hepatitis or cirrhosis due to any cause)
* Past medical history of: neoplastic disease, congestive cardiac failure, chronic obstructive pulmonary disease, insulin-dependent diabetes or renal disease
* Pregnancy
* No access to telephone
* Not able to come for follow up visit on day 3 or 4.
* Already taking antibiotics at the time of presentation
* Symptoms present for more than 2 weeks
* Presence of any sign of severe diseases as defined by the British Thoracic Society modified CRP-65 system for severity scoring of pneumonia in primary care.

For children (Age ≥ 6 years and \< 16 years) additional exclusion criteria include: Tachypnea, signs of chest wall in drawing, reduced consciousness, confusion, dehydration, hypothermia, severe malnutrition, unable to feed or drink, vomiting, and convulsions.
B: Inclusion Criteria:

* ≥ 18 years old
* A primary clinical diagnosis in the ED of acute LRTI (\< 28 days duration)
* Clinician willing to consider procalcitonin in antibiotic decision-making

Exclusion Criteria:

* Systemic antibiotics before ED presentation (All prophylactic antibiotic regimens, OR received \>1 dose within 72 hours prior to ED presentation)
* Current vasopressor use
* Mechanical ventilation (via endotracheal tube)
* Known severe immunosuppression
* Accompanying non-respiratory infections
* Known lung abscess or empyema
* Chronic dialysis
* Metastatic cancer
* Surgery in the past 7 days (excluding minor surgery such as skin biopsy)
* Incarcerated or homeless
* Enrolled in ProACT in the past 30 days
C: Inclusion Criteria:

* Patients aged ≥1 year presenting to selected primary healthcare centres
* Tympanic temperature \>37.5°c or history of fever ≤ 14 days.

Exclusion Criteria:

* Patients that in view of the study nurse are in need of emergency referral to a higher-level facility, as indicated by either 1) impaired consciousness or 2) inability to take oral medication.
* In sites that routinely test for malaria, patients with a positive malaria rapid diagnostic test or microscopy will be excluded
* The main complaint is a trauma and/or injury
* Suspicion of tuberculosis (any medical history and/or physical examination suggesting tuberculosis)
* Suspicion of Urinary Tract Infections (any medical history and/or physical examination suggesting urinary tract infections)
* Suspicion of local skin/dental abscess (any medical history and/or physical examination suggesting a local skin/dental abscess
* Any presenting symptom present for more than 14 days
* Bleeding, including otorrhagia, haematemesis, haemoptysis, haemorrhagic petechiae, haematuria, bloody diarrhoea.
* Not able to comply with the follow-up at Day 5 (+ / - 1 day).
D: Inclusion Criteria:

* Ontario primary care physicians
* Prescribe more antibiotics by volume than 75% of Ontario primary care physicians
* A College of Physicians and Surgeons of Ontario number in 2017-2018

Exclusion Criteria:

* None

Answer: D