Reducing Unnecessary Antibiotic Prescriptions in Primary Healthcare in Saskatchewan by Identifying High Prescribers

Study Overview
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Brief Summary
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Approximately 90% of antibiotics are prescribed in primary healthcare (PHC) in Canada (Public Health Agency of Canada, 2020), making this an important sector for antimicrobial stewardship. Upper respiratory tract infections (URTIs) represent a common indication in PHC for which antibiotics are often prescribed unnecessarily (Leis et al, 2020; Schwartz et al., 2020). Reducing unnecessary antibiotic treatment in this sector is a vital part of contributing to minimizing the global burden of antibiotic resistance. The goal of this research project is to reduce the number of antibiotic prescriptions among family physicians identified as high prescribers in Saskatchewan. To achieve this, the investigators will send letters to the top 25th percentile of high prescribers in PHC. The letters will contain data indicating the prescribers high antimicrobial usage as well as guidance for reducing unnecessary prescriptions and promoting appropriate lengths of prescriptions for upper respiratory tract infections.

Official Title
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Reducing Unnecessary Antibiotic Prescriptions in Primary Healthcare in Saskatchewan by Identifying High Prescribers

Conditions
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Upper Respiratory Tract Infections

Intervention / Treatment
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* Behavioral: Audit and Feedback Letter


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: must be a practicing family physician in Saskatchewan top 25th percentile of antimicrobial prescribers Exclusion Criteria: fewer than 12 months of historical prescribing data available
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Audit and Feedback Letter<br>This group will receive 2 audit and feedback letters and a study closure letter. | Behavioral: Audit and Feedback Letter<br>* Physicians in the Audit and Feedback Letter Arm will receive an initial letter indicating their high prescriber status with guidance on reducing unnecessary antimicrobial use. They will also receive a follow-up letter at the 6 month mark indicating any change in prescribing habits. There will be a study closure letter mailed at the 12 month mark.<br>|
| No Intervention: No Audit and Feedback Letter<br>This group will only receive a study closure letter. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total Antibiotic Prescriptions | Total number of antibiotic prescriptions compared to covariate-adjusted baseline number of prescriptions prior to the intervention. | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total Prolonged-Duration Prescription | Number of prescriptions longer than 7 days. | 12 months | 
| Total Days of Therapy | Number of days of therapy of antimicrobials for each provider. | 12 months | 
| Antibiotic Cost | Total cost of prescribed antibiotics. | 12 months | 
| Total Specific Antibiotic Prescriptions | Number of prescriptions for specific antibiotics. | 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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audit and feedback, primary healthcare, antimicrobials