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

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

Official Title
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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)

Conditions
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Infection

Intervention / Treatment
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* Behavioral: Emphasis on the Choosing Wisely Viral Prescription Pad


Participation Criteria
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Eligibility Criteria
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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
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Cluster Randomized Control Trial
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention Group - Viral prescription pad + emphasis<br>Physicians in this group will receive their usual MyPractice: Primary Care report from Ontario Health. This report will include antibiotic prescribing indicators as well as a link to the viral prescription pad. As part of the intervention, these physicians will also receive additional emphasis on the viral prescription pad by 1) encouraging it in the dissemination email of the MyPractice feedback report, and (2) mailing a paper version of the viral prescription pad with instructions on embedding the viral prescription pad into the recipient's EMR. | Behavioral: Emphasis on the Choosing Wisely Viral Prescription Pad<br>* 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.<br>|
| No Intervention: Control group<br>Physicians in this group will receive their usual MyPractice: Primary Care report from Ontario Health. This report will include antibiotic prescribing indicators as well as a link to the viral prescription pad. This group will not receive any additional emphasis on the viral prescription pad and will not receive a paper copy in the mail. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Antibiotic prescribing rate | Total number of antibiotic prescriptions per 1000 65+ patient visits | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion Antibiotic Rx with Prolonged Duration | Antibiotics prescribed for more than 7 days per episode | 6 months | 
| Proportion Antibiotic Rx with Prolonged Duration | Antibiotics prescribed for more than 7 days per episode | 12 months | 
| Antibiotic drug costs | Cost in CDN$ | 6 months | 
| Antibiotic drug costs | Cost in CDN$ | 12 months | 
| 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 | 
| 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 | 
| Total Antibiotic Days of Therapy | Total number DOTs per 1000 65+ patient visits | 6 months | 
| Total Antibiotic Days of Therapy | Total number DOTs per 1000 65+ patient visits | 12 months | 
| Proportion of broad spectrum antibiotic prescriptions | antibiotic prescriptions that are broad spectrum | 6 months | 
| Proportion of broad spectrum antibiotic prescriptions | antibiotic prescriptions that are broad spectrum | 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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audit and feedback, antibiotics