Optimizing Antibiotics Prescription
- Conditions
- Antimicrobial Resistance
- Interventions
- Behavioral: Diagnosis Mandate and Feedback
- Registration Number
- NCT06436690
- Lead Sponsor
- Penn State University
- Brief Summary
Interventions that are low-cost, do not add substantially to the physician workload, are consistent with good physician practices and WHO guidelines, and serve as a reminder on the risks of overprescribing antibiotics are critically needed. The overall goal of the proposed project is to test the effect of a behavioral intervention targeted to junior physicians-specifically, requiring them to specify the diagnosis in the prescription note and providing feedback-on their antibiotics prescription rate; examine the intervention's effects across gender and caste; and draw lessons for scaling up the intervention.
- Detailed Description
Antimicrobial resistance (AMR) is one of the top ten threats to global health. Limited existing evidence from Nepal, the site for the proposed study, suggests that physicians "err on the side of caution" by prescribing antibiotics even for viral conditions, which contributes to AMR. Interventions that are low-cost, do not add substantially to the physician workload, are consistent with good physician practices and WHO guidelines, and serve as a reminder on the risks of overprescribing antibiotics are critically needed. The overall goal of the proposed project is to test the effect of a behavioral intervention targeted to junior physicians-specifically, requiring them to specify the diagnosis in the prescription note and providing feedback-on their antibiotics prescription rate; examine the intervention's effects across gender and caste; and draw lessons for scaling up the intervention.
The specific objectives are the following:
Objective 1. Assess the effect of a behavioral intervention targeted to junior physicians on antibiotics prescription rate, including by caste and gender of the patient. A stepped-wedge randomized control trial (RCT) will be conducted among 60 junior physicians in five hospitals (1 government, 2 private teaching, and 2 community) in Nepal. The intervention will be rolled out sequentially across the hospitals and data will be collected from patients (n=3,600) both before and after the intervention. The intervention will consist of three components: (a) a Refresher Training on AMR, (b) a Diagnosis Mandate, and (c) an Individualized Feedback.
Objective 2. Identify barriers to scaling up the intervention beyond the study's site and strategies for their mitigation. After preliminary analysis of the quantitative data, key informant interviews with national- and provincial- level health policy makers (n=5), and in-depth interviews with physicians (n=5) and hospital managers (n=5) will be conducted.
Objective 3. Assess the extent to which physicians prescribe antibiotics correctly. From a subset of patients (n=120, i.e., 2 per physician), more detailed medical information will be collected and analyzed from their outpatient booklet.
This registration is for objective 1. Therefore, only details pertaining to that objective will be provided here.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 60
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SEQUENTIAL
- Arm && Interventions
Group Intervention Description Diagnosis Mandate and Feedback Diagnosis Mandate and Feedback The intervention will consist of three components: (a) a Refresher Training on antimicrobial resistance, (b) a Diagnosis Mandate, and (c) an Individualized Feedback.
- Primary Outcome Measures
Name Time Method Antibiotics prescription rate 1-3 months before the intervention and 3-5 months after the intervention, depending on the timing of the intervention which varies by hospital. The number of patient visits in which antibiotics are prescribed by the total number of visits
- Secondary Outcome Measures
Name Time Method Differences in prescription rates by patient's gender 1-3 months before the intervention and 3-5 months after the intervention, depending on the timing of the intervention which varies by hospital. The number of patient visits in which antibiotics are prescribed by the total number of visits, by male and female
Differences in prescription rates by patient's ethnicity (advantaged versus disadvantaged) 1-3 months before the intervention and 3-5 months after the intervention, depending on the timing of the intervention which varies by hospital. The number of patient visits in which antibiotics are prescribed by the total number of visits, by advantaged and disadvantaged status
Trial Locations
- Locations (2)
Pennsylvania State University
🇺🇸University Park, Pennsylvania, United States
Institute for Social and Environmental Research - Nepal
🇳🇵Bharatpur, Bagmati, Nepal