Antimicrobial Stewardship for Primary Care Pediatricians

Study Overview
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Brief Summary
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The purpose of the study is to determine if physician education coupled with audit and feedback of antibiotic prescribing can improve antibiotic prescribing by primary care clinicians.

Detailed Description
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Using a large, diverse pediatric primary care network sharing a comprehensive electronic health record (EHR), a cluster-randomized trial will be performed to determine the effectiveness of an outpatient antimicrobial stewardship bundle, including treatment guidelines coupled with audit and feedback of physician prescribing, to curb inappropriate antibiotic prescribing for respiratory tract infections. Aim 1: To determine the impact of an outpatient antimicrobial stewardship bundle within a pediatric primary care network on antibiotic prescribing for conditions for which antibiotics are not indicated. Hypothesis: Antimicrobial stewardship will decrease rates of antibiotic prescribing for conditions for which antibiotics are not indicated. Aim 2: To determine the impact of an outpatient antimicrobial stewardship bundle within a pediatric primary care network on broad-spectrum antibiotic prescribing for conditions for which narrow-spectrum antibiotics are indicated. Hypothesis: Antimicrobial stewardship will decrease the rate of broad-spectrum antibiotic prescribing for conditions for which narrow-spectrum antibiotics are indicated.

Official Title
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Reducing Inappropriate Prescribing of Antibiotics by Primary Care Clinicians

Conditions
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Acute Sinusitis, Streptococcal Pharyngitis, Pneumonia, Viral Infection

Intervention / Treatment
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* Behavioral: Antimicrobial Stewardship Bundle


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Primary care pediatric practices within the CHOP Care Network Exclusion Criteria: Academic primary care pediatric practices within the CHOP Care Network Providers entering a practice after the start of the intervention Providers with less than 25 antibiotic prescriptions in the 6 months prior to the start of the intervention
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: Treatment
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Antimicrobial Stewardship Bundle<br>An intervention bundle to reduce outpatient antibiotic use in children will include education, creation of and access to guidelines, and audit of and feedback on individual prescribing within the context of achievable benchmarks. | Behavioral: Antimicrobial Stewardship Bundle<br>* Guidelines, Education, Audit and Feedback<br>|
| No Intervention: Control<br>Control sites will be within strata to maintain balance of treatment arm within strata | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Reduction in the rate of broad-spectrum antibiotic prescribing for targeted conditions for which narrow-spectrum antibiotic therapy is indicated | The primary outcome measure seeks to determine if the incorporation of treatment guidelines coupled with audit and feedback of physician prescribing can reduce the the rate of antibiotic prescribing for targeted conditions for which antibiotic therapy is not indicated. | from 20 months prior through 13 months post intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The rate of antibiotic prescribing for targeted conditions for which antibiotic therapy is not indicated | The secondary outcome measure seeks to determine the rate of broad-spectrum antibiotic prescribing for targeted conditions for which narrow-spectrum antibiotic therapy is indicated. Thus, two classes of diagnoses will be collected: 1) respiratory tract infections for which no antibiotics are indicated, represented by a group codes indicating common infections with presumed viral etiology and 2) bacterial respiratory tract infections for which narrow spectrum antibiotics are indicated | from 20 months prior through 13 months post intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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antimicrobial stewardship program, inappropriate prescribing of antibiotics, physician prescribing, antibiotic prescribing for respiratory tract infections, respiratory tract infections