Decreasing Antibiotic Duration for Skin and Soft Tissue Infection Using Behavioral Economics in Primary Care

Not Applicable

Active, not recruiting

• Conditions: Cellulitis; Abscess; Drain Abscess; Impetigo; Skin Infection; Behavioral Economics; Antibiotic Duration
• Interventions: Behavioral: Default Duration order Panel

• Registration Number: NCT05226260
• Lead Sponsor: Nationwide Children's Hospital

Brief Summary

Study the efficacy of a package of behavioral economics strategies (versus an education-only control condition) in altering clinician behavior regarding antibiotic prescription duration for skin and soft tissue infection (SSTI).

Detailed Description

The investigators propose a prospective, cluster randomized trial of Epic order panels in the 14 Nationwide Children's Hospital (NCH) primary care clinics. Investigators have designed user-friendly Epic order panels from which providers may select guideline concordant antibiotics by simply typing in a diagnosis (cellulitis) or antibiotic name. These order panels are prepopulated with the default, short-course (guideline-concordant) antibiotic duration, saving clinicians several clicks within the electronic medical record (EMR). If a provider changes the prescribed duration from the one defaulted, a free text box will appear for them to write an acknowledgement reason (accountable justification). All 14 clinics will receive baseline education (control condition) about common infections and local and national guidelines for antibiotic choice and duration of treatment. Clinician prescribers will also be instructed about the presence of a basic order panel. The full functionality of the default \[short/desired\] duration order panel will only be released to intervention clinics. The order panels will be restricted in Epic to clinics randomized to the intervention. The investigators hypothesize that clinics with the intervention will have higher rates of short course antibiotics for SSTI versus control clinics.

Study Timeline

• Study Start: 2021-11-01
• Study First Submitted: 2021-11-03
• Study First Submitted QC: 2022-02-01
• Study First Posted: 2022-02-07
• Status Verified: 2024-07
• Last Update Submitted: 2024-07-15
• Last Update Posted: 2024-07-17
• Primary Completion: 2025-01-01
• Study Completion: 2025-01-01

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: All
• Target Recruitment: 98

Inclusion Criteria

• diagnosis codes A46 (cellulitis), L03 (cellulitis and acute lymphangitis), J34 or L02 (abscess, furuncle), or L01 (impetigo) AND
• those who received a prescription for an enteral antibiotic
• patient's treated in Nationwide Children's Hospital primary care clinics

Read More

Exclusion Criteria

• Patients less than 3 months of age
• Animal bite
• Human bite
• Foreign body
• Diagnosis of hidradenitis suppurativa
• Immunocompromising conditions (primary immune deficiency, chemotherapy, etc)
• burns

Read More

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Intervention	Default Duration order Panel	Intervention clinics receiving fully functional Epic order panel with set default \[short\] duration by diagnosis: for cellulitis and drained abscess, 5 days. For impetigo and undrained abscess, 7 days.

Primary Outcome Measures

Name	Time	Method
Rate of short antibiotics	12 months	Rates of long and short antibiotics will be analyzed on the clinic and provider level for both intervention and control groups

Trial Locations

Locations (1)

Nationwide Children's Hospital Primary Care Clinics; 🇺🇸 Columbus, Ohio, United States