Feedback to Improve Rational Strategies of Antibiotic Initiation and Duration in Long Term
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Antibiotic Initiation
- Sponsor
- Institute for Clinical Evaluative Sciences
- Enrollment
- 356
- Locations
- 1
- Primary Endpoint
- Antibiotic initiation
- Status
- Completed
- Last Updated
- 4 years ago
Overview
Brief Summary
There is a high rate of inappropriate antibiotic use in long-term care (LTC) facilities, with both unnecessary initiation and prolongation of treatments. Although there are challenges to rational antibiotic use in LTC, the variability in antibiotic initiation and use of prolonged treatment durations is driven by prescriber tendencies rather than resident characteristics. Audit-and-feedback is a well-established intervention to improve professional practices, and is ideally suited for use to improve antibiotic prescribing tendencies in LTC. The literature is saturated with trials indicating benefit of audit-and-feedback, but is in dire need of studies to identify methods to improve the impact of this technique. Health Quality Ontario (HQO), a key partner in the FIRST AID-LTC research program, is already providing audit-and-feedback for other inappropriate prescribing practices in LTC, and has identified antibiotic prescribing as a priority focus.
Detailed Description
Overarching Goals The overarching goals of FIRST AID - LTC are two-fold: 1. Improve rational antibiotic prescribing by physicians to minimize harms among LTC residents. 2. Advance the science of audit-and-feedback to improve physician prescribing practices. Specific Aims To improve rational antibiotic prescribing in LTC: 1. by decreasing unnecessary initiation of antibiotic treatments among Ontario LTC residents, as well as the variability in initiation rates across LTC prescribers. 2. by decreasing unnecessary prolonged duration of antibiotic treatments among Ontario LTC residents, as well as the variability in prolonged duration treatment use across LTC prescribers. To advance audit-and-feedback implementation science: 1. by evaluating whether a dynamic audit-and-feedback report highlighting antibiotic prescribing can lead to greater reductions in antibiotic use, than a static paginated report Anticipated Contributions to Health-Related Knowledge Although the literature is inundated with trials examining the impact of audit-and-feedback compared to usual care, there is a need for studies to improve audit-and-feedback delivery. FIRST AID-LTC will test optimal delivery and peer comparison techniques for audit-and-feedback. The knowledge learned can be extrapolated to antibiotic interventions in LTC in other provinces across Canada, as well more broadly to inappropriate medication prescribing practices in LTC. Anticipated Contributions to Health Care, Health Systems and Health Outcomes FIRST AID-LTC will lead to immediate reductions in excess antibiotic use in Ontario LTC facilities, which in turn should result in substantial reductions in direct drug costs, as well as downstream complications of allergy, organ toxicity, C. difficile infections and antimicrobial resistance. With easy transferability to other Canadian provinces, the improvements in cost-savings and patient outcomes could be massive in scope.
Investigators
Nick Daneman
Adjunct Scientist
Institute for Clinical Evaluative Sciences
Eligibility Criteria
Inclusion Criteria
- •An individual having a minimum of 2 records on separate days within the quarter meeting any combination of the following criteria:
- •a record for a non-emergency long-term care inpatient services OR
- •an Ontario Drug Benefits record administered in long-term care
- •Index date = The analysis will be anchored on the most recent of either of the records above within a given quarter or their date of death (whichever date is earliest)
Exclusion Criteria
- •Non-Ontario resident at index date
- •Invalid age (age\<19 or age\>115) at index date
- •Missing or invalid sex or date of birth at index date
- •Death date is \>7 days before index date
- •If the individual does not live in a nursing home or home for the aged
- •Cannot be linked to a Most Responsible Physician (MRP) (see methodology below)
- •To Identify the Most Responsible Physician (MRP) Using Virtual Rostering
- •For each patient in the above resident cohort, the study team will retrieve all records from health care providers in the 6 month period preceding the index date (180 days), keeping only records from physicians who have a specialty of 1) general practice, 2) community medicine or 3) geriatrics.
- •Steps for MRP assignment:
- •Step 1) The study team will first select physicians with the highest count of records for the monthly management of a nursing home or home for the aged. This is completed for as many residents as possible.
Outcomes
Primary Outcomes
Antibiotic initiation
Time Frame: 3 months
Median % of patients initiated on an antibiotic
Antibiotic duration
Time Frame: 3 months
Median % of antibiotic treatments prolonged \>7 days
Secondary Outcomes
- ER visit or hospitalization for infection(3 months)
- ER visit or hospitalization for antibiotic harms(3 months)
- Net Clinical impact(3 months)
- Anti-psychotic use(3 months)
- Benzodiazepine use(3 months)