Clinical trial NCT05044052: Does Inclusion of Viral Prescription Pad Resources Increase Responsiveness to Feedback About Antibiotic Prescribing in Primary Care
Official title: 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)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Infection
Keywords: audit and feedback
antibiotics
Lead sponsor: Women's College Hospital
Sponsor class: OTHER
Collaborators: name: Ontario Agency for Health Protection and Promotion
name: College of Family Physicians of Canada
name: Canadian Institutes of Health Research (CIHR)
First posted: 2021-09-14
Enrollment: 3379
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Cluster Randomized Control Trial
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: 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: 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.

Eligibility criteria: 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

Primary outcomes:
measure: Antibiotic prescribing rate
timeFrame: 6 months
Secondary outcomes:
measure: Proportion Antibiotic Rx with Prolonged Duration
timeFrame: 6 months
measure: Proportion Antibiotic Rx with Prolonged Duration
timeFrame: 12 months
measure: Antibiotic drug costs
timeFrame: 6 months
measure: Antibiotic drug costs
timeFrame: 12 months
measure: Antibiotics prescribed for viral infections
timeFrame: 6 months
measure: Antibiotics prescribed for viral infections
timeFrame: 12 months
measure: Total Antibiotic Days of Therapy
timeFrame: 6 months
measure: Total Antibiotic Days of Therapy
timeFrame: 12 months
measure: Proportion of broad spectrum antibiotic prescriptions
timeFrame: 6 months
measure: Proportion of broad spectrum antibiotic prescriptions
timeFrame: 12 months
Other outcomes:
Locations:
city: Toronto
country: Canada
facility: Women's College Hospital
state: Ontario
Study officials:
affiliation: Women's College Hospital
name: Noah M Ivers, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Shuldiner J, Schwartz KL, Langford BJ, Ivers NM; Ontario Healthcare Implementation Laboratory study team. Optimizing responsiveness to feedback about antibiotic prescribing in primary care: protocol for two interrelated randomized implementation trials with embedded process evaluations. Implement Sci. 2022 Feb 14;17(1):17. doi: 10.1186/s13012-022-01194-8.