Building a National Framework to Combat Antimicrobial Resistance in Primary Care (CANBuild-AMR): Study Protocol for an Impact Evaluation of the British Columbia Prescriber Feedback Program
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 7,626
- 试验地点
- 1
- 主要终点
- Weekly rate of incident oral antibiotic prescribing
研究概览
简要总结
The goal of this study is to evaluate an educational intervention that aims to reduce the number of unnecessary antibiotics prescribed by family physicians and nurse practitioners in British Columbia, Canada.
The intervention materials include a confidential personalized prescribing "portrait" and an evidence-based educational summary (therapeutics letter), accompanied by an introduction letter.
The main research questions are:
- Will the intervention lead to a reduction in the overall number of antibiotics prescriptions started?
- Will the intervention lead to a reduction in the proportion of antibiotics prescribed that are likely unnecessary, especially prescriptions for upper respiratory tract infections, acute bronchitis, acute sinusitis?
Researchers will conduct an intervention study with family physicians and nurse practitioners in British Columbia, Canada. Participant clinicians will be randomly assigned to one of two groups. The Early Group will consist of 80% of the participants and will receive the intervention (prescribing portrait, evidence summary, and introduction letter) at the start of the study. The Delayed Group will consist of 20% of participants and will receive the intervention about nine months later. This study design allows most practitioners to receive the intervention early while still allowing time to compare the two groups to assess the impact. To estimate the impact of the intervention, researchers will use administrative health data to compare the prescribing of the Early Group with prescribing of the Delayed Group.
详细描述
Audit and feedback is a well-established strategy for improving the quality of care in primary healthcare settings. It involves the systematic collection and analysis of healthcare data, followed by the provision of information to healthcare providers to improve the quality of care.
Antimicrobial resistance is a growing global health problem, fueled in part by unnecessary antibiotic use. Most antibiotics are prescribed in the community, especially for respiratory infections, and many of these prescriptions provide little or no benefit, particularly for viral illnesses. Effective antimicrobial stewardship in primary care is essential.
Based in British Columbia, Canada, the Therapeutics Initiative's Portrait program provides family physicians and nurse practitioners with individualized prescribing data compared with their peers, paired with evidence-based messaging, and a concise statement summarizing the desired change in prescribing behavior. The Portrait program implements a series of pragmatic trials to improve prescribing where clinicians are randomized into an early intervention and a delayed control group.
The current study evaluates the impact of an antibiotic prescribing portrait and evidence summary focused on reducing overall antibiotic use and avoiding routine prescribing for common respiratory tract infections (upper respiratory tract infections, acute bronchitis, acute sinusitis) in primary care. The prescribing portrait title is "What are your antibiotic prescribing rates?" and is accompanied by a therapeutics letter (evidence summary) entitled "Avoid antibiotics for self-limited viral infections" and an introduction letter.
The portrait contains two key recommendations based on recent systematic reviews on the effect of antibiotic prescribing on antimicrobial resistance in primary care: 1) Reduce the number of your patient visits that end with an antibiotic prescription, and 2) Avoid routinely prescribing antibiotics for upper respiratory tract infections, acute bronchitis, and acute sinusitis. The first recommendation is accompanied by a bar graph showing the prescriber their number of antibiotic prescriptions per 100 patients in 2024 in comparison with the median practice in BC and an achievable target. The second recommendation is accompanied by a bar graph showing the prescriber's percentage of antibiotic prescriptions identified as likely unnecessary in 2024 in comparison with the median practice in BC and an achievable target.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Sequential
- 主要目的
- Health Services Research
- 盲法
- Single (Participant)
盲法说明
Participants will not be masked to their group allocation but will not be aware of the analytical approach. The statistical analysis plan is being developed by an evaluation committee who are masked to the trial arm allocation.
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Practitioner Inclusion Criteria:
- •Registered in 2024 with the BC Medical Services Plan (MSP) with:
- •A valid MSP billing number;
- •Status of Salaried, Private Practice, Temporary Licence, or Post Graduate;
- •Prescribed >100 dispensed medications in 2024.
排除标准
- •Previously opted out of the Therapeutics Initiative Portrait program
- •Patient Exclusion Criteria:
- •Age <18 years at time of oral antibiotic dispensation;
- •Received PharmaCare benefits through the Palliative Care program at any time during the baseline or study period;
- •Hospitalized within 1 week prior to an antibiotic prescription at any time during the baseline or study period;
- •On chronic suppressive antibiotic therapy (≥90 days' supply of any antibiotic dispensed) during the baseline or study period
研究组 & 干预措施
Early Group - Prescribing portrait audit and feedback
The Early Group of clinicians (n=6100) will be mailed the prescribing portrait audit-and-feedback intervention (prescribing portrait, evidence summary, and introduction letter) at the study initiation in February 2026.
干预措施: Prescribing portrait audit and feedback (Behavioral)
Delayed control - Prescribing portrait audit-and-feedback
Delayed control group (n=1526) of clinicians will be mailed the audit-and-feedback intervention (prescribing portrait, evidence summary, and introduction letter) approximately 9 months after Group 1 (Early Group).
干预措施: Prescribing portrait audit and feedback (Behavioral)
结局指标
主要结局
Weekly rate of incident oral antibiotic prescribing
时间窗: From trial initiation to 30 days, 3, 6, and 9 months post-intervention
The primary outcome is the number of incident oral antibiotic prescriptions per practitioner per week. Follow-up time will be calculated for each practitioner in the 52 weeks before and 39 weeks after the portrait is mailed to the Early group. A practitioner will count as contributing a full week (7 days) of follow-up if, during that week, they either: 1) wrote at least one prescription (recorded in PharmaNet), or 2) billed the Medical Services Plan for at least one patient visit. Weekly prescribing rates will be plotted by Early and Delayed groups and analyzed using Poisson regression with generalized estimating equations to account for repeated measures. Models will adjust for cohort (Early vs. Delay), age, sex, rural practice, and provider type. The intervention effect will be estimated using a pre-post level-change variable and its interaction with cohort status, representing the adjusted mean impact of the portrait.
次要结局
- Weekly rate of 'likely unnecessary' antibiotic prescriptions(From trial initiation to 30 days, 3, 6, and 9 months post-intervention)
- Weekly rate of 'likely unnecessary' condition-specific antibiotic prescriptions(From trial initiation to 30 days, 3, 6, and 9 months post-intervention)
研究者
Colin Dormuth
Associate Professor
University of British Columbia