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)
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 3,379
- 试验地点
- 2
- 主要终点
- Antibiotic prescribing rate
研究概览
简要总结
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.
详细描述
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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- Double (Investigator, Outcomes Assessor)
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Family physicians who sign up for the MyPractice reports by September 2021
排除标准
- •Family physicians who did not sign up for the MyPractice reports by September 2021
结局指标
主要结局
Antibiotic prescribing rate
时间窗: 6 months
Total number of antibiotic prescriptions per 1000 65+ patient visits
次要结局
- Proportion of broad spectrum antibiotic prescriptions(12 months)
- Total Antibiotic Days of Therapy(12 months)
- Proportion Antibiotic Rx with Prolonged Duration(12 months)
- Antibiotic drug costs(12 months)
- Antibiotics prescribed for viral infections(12 months)
研究者
Noah Ivers
Family Physician, Canada Research Chair (Tier 2) in Implementation of Evidence Based Practice
Women's College Hospital