Effect of Antibiotic-Prescribing Feedback to High-Volume Primary Care Physicians on Number of Antibiotic Prescriptions

医学 药方 抗生素 泊松回归 抗菌管理 随机对照试验 抗生素耐药性 初级保健 急诊医学 内科学 家庭医学 人口 环境卫生 生物 微生物学 药理学
作者
Kevin L. Schwartz,Noah Ivers,Bradley J. Langford,Monica Taljaard,Drew Neish,Kevin A. Brown,Valerie Leung,Nick Daneman,Javed Alloo,Michael E. Silverman,Emily Shing,Jeremy Grimshaw,Jerome A. Leis,Julie H. Wu,Gary Garber
出处
期刊:JAMA Internal Medicine [American Medical Association]
卷期号:181 (9): 1165-1165 被引量:43
标识
DOI:10.1001/jamainternmed.2021.2790
摘要

Importance

Antibiotic overuse contributes to adverse drug effects, increased costs, and antimicrobial resistance.

Objective

To evaluate peer-comparison audit and feedback to high-prescribing primary care physicians (PCPs) and assess the effect of targeted messaging on avoiding unnecessary antibiotic prescriptions and avoiding long-duration prescribing.

Design, Setting, and Participants

In this 3-arm randomized clinical trial, administrative data collected from IQVIA's Xponent database were used to recruit the highest quartile of antibiotic-prescribing PCPs (n = 3500) in Ontario, Canada.

Interventions

Physicians were randomized 3:3:1 to receive a mailed letter sent in December 2018 addressing antibiotic treatment initiation (n = 1500), a letter addressing prescribing duration (n = 1500), or no letter (control; n = 500). Outliers at the 99th percentile at baseline for each arm were excluded from analysis.

Main Outcomes and Measures

The primary outcome was total number of antibiotic prescriptions over 12 months postintervention. Secondary outcomes were number of prolonged-duration prescriptions (>7 days) and antibiotic drug costs (in Canadian dollars). Robust Poisson regression controlling for baseline prescriptions was used for analysis.

Results

Of the 3465 PCPs included in analysis, 2405 (69.4%) were male, and 2116 (61.1%) were 25 or more years from their medical graduation. At baseline, PCPs receiving the antibiotic initiation letter and duration letter prescribed an average of 988 and 1000 antibiotic prescriptions, respectively; at 12 months postintervention, these PCPs prescribed an average of 849 and 851 antibiotic prescriptions, respectively. For the primary outcome of total antibiotic prescriptions 12 months postintervention, there was no statistically significant difference in total antibiotic use between PCPs who received the initiation letter compared with controls (relative risk [RR], 0.96; 97.5% CI, 0.92-1.01;P = .06) and a small statistically significant difference for the duration letter compared with controls (RR, 0.95; 97.5% CI, 0.91-1.00;P = .01). For PCPs receiving the duration letter, this corresponds to an average of 42 fewer antibiotic prescriptions over 12 months. There was no statistically significant difference between the letter arms. For the initiation letter, compared with controls there was an RR of 0.98 (97.5% CI, 0.93-1.03;P = .42) and 0.97 (97.5% CI, 0.92-1.02;P = .19) for the outcomes of prolonged-duration prescriptions and antibiotic drug costs, respectively. At baseline, PCPs who received the duration letter prescribed an average of 332 prolonged-duration prescriptions with $14 470 in drug costs. There was an 8.1% relative reduction (RR, 0.92; 97.5% CI, 0.87-0.97;P < .001) in prolonged-duration prescriptions, and a 6.1% relative reduction in antibiotic drug costs (RR, 0.94; 97.5% CI, 0.89-0.99;P = .01). This corresponds to an average of 24 fewer prolonged-duration prescriptions and $771 in drug cost savings per PCP over 12 months.

Conclusions and Relevance

In this randomized clinical trial, a single mailed letter to the highest-prescribing PCPs in Ontario, Canada providing peer-comparison feedback, including messaging on limiting antibiotic-prescribing durations, led to statistically significant reductions in total and prolonged-duration antibiotic prescriptions, as well as drug costs.

Trial Registration

ClinicalTrials.gov Identifier:NCT03776383

科研通智能强力驱动
Strongly Powered by AbleSci AI
科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
orixero应助坦率的尔丝采纳,获得10
1秒前
陶醉的熊发布了新的文献求助10
1秒前
笑点低的思松完成签到,获得积分10
2秒前
4秒前
6秒前
7秒前
SSS发布了新的文献求助10
10秒前
10秒前
陶醉的熊完成签到,获得积分10
12秒前
ru123456发布了新的文献求助10
15秒前
17秒前
杏林靴子完成签到,获得积分10
17秒前
19秒前
renshiq完成签到,获得积分10
19秒前
20秒前
bkagyin应助Tzzl0226采纳,获得10
21秒前
薄荷发布了新的文献求助30
23秒前
23秒前
23秒前
renxuda完成签到,获得积分10
25秒前
27秒前
如初发布了新的文献求助10
27秒前
震震发布了新的文献求助10
28秒前
29秒前
所所应助谨慎的咖啡豆采纳,获得10
32秒前
ru123456完成签到,获得积分10
32秒前
Tzzl0226发布了新的文献求助10
33秒前
科研通AI5应助111采纳,获得10
33秒前
牛马人生完成签到,获得积分10
33秒前
瘦瘦谷槐完成签到,获得积分10
34秒前
朝朝完成签到 ,获得积分10
35秒前
breeze2000应助zmx采纳,获得10
37秒前
wy.he应助wu采纳,获得10
38秒前
39秒前
lhp完成签到,获得积分10
41秒前
41秒前
万能图书馆应助罗小小采纳,获得10
43秒前
千程发布了新的文献求助10
44秒前
just完成签到,获得积分10
45秒前
45秒前
高分求助中
【此为提示信息,请勿应助】请按要求发布求助,避免被关 20000
ISCN 2024 – An International System for Human Cytogenomic Nomenclature (2024) 3000
Continuum Thermodynamics and Material Modelling 2000
Encyclopedia of Geology (2nd Edition) 2000
105th Edition CRC Handbook of Chemistry and Physics 1600
T/CAB 0344-2024 重组人源化胶原蛋白内毒素去除方法 1000
Maneuvering of a Damaged Navy Combatant 650
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 物理 生物化学 纳米技术 计算机科学 化学工程 内科学 复合材料 物理化学 电极 遗传学 量子力学 基因 冶金 催化作用
热门帖子
关注 科研通微信公众号,转发送积分 3775692
求助须知:如何正确求助?哪些是违规求助? 3321312
关于积分的说明 10204776
捐赠科研通 3036237
什么是DOI,文献DOI怎么找? 1666031
邀请新用户注册赠送积分活动 797258
科研通“疑难数据库(出版商)”最低求助积分说明 757783