The Use of Electronic Medical Records to Change Clinician Behaviour and Increase Adherence to the Choosing Wisely Recommendations

The investigators conducted a clustered randomized trial of primary care providers in Manitoba, Canada participating in the Manitoba Primary Care Research Network (MaPCReN) to assess the impact of A&F interventions to change prescribing and screening rates.

In January 2016, MaPCReN included 239 providers in 46 practices across Manitoba, representing ~20% of Manitoba primary care providers. MaPCReN recruits consenting primary care providers (family physicians, nurse practitioners and community pediatricians) that receive semi-annual feedback reports for practice reflection and quality improvement. Feedback reports provide practice-level details including disease prevalence and clinical characteristics of patients, reported in comparison to other providers at the same practice, health region and provincially

Investigators implemented an A&F cycle reporting on practice behaviours related to four Choosing Wisely Canada (CWC) recommendations.

A) "Don't use antibiotics for upper respiratory infections that are likely viral in origin, such as influenza-like illness, or self-limiting, such as sinus infections of less than seven days of duration." • Bacterial infections of the respiratory tract are rare and usually only secondary complications from initial viral infections. Antibiotics are rarely indicated for upper respiratory illness and patients may suffer adverse effects from antibiotics.

B) Don't routinely measure Vitamin D in low risk adults.