Routine Prescription Feedback and Peer Comparison to Lower Antibiotic Prescriptions in Primary Care

This study is currently recruiting participants. (see Contacts and Locations)
Verified August 2014 by University Hospital, Basel, Switzerland
Sponsor:
Collaborator:
Swiss National Science Foundation
Information provided by (Responsible Party):
University Hospital, Basel, Switzerland
ClinicalTrials.gov Identifier:
NCT01773824
First received: August 24, 2012
Last updated: August 19, 2014
Last verified: August 2014
  Purpose

To evaluate the effect of a continuous postal and web-based feedback and peer comparison system of individual antibiotic prescription rates on the prescription behaviour of primary care physicians in Switzerland.


Condition Intervention
Upper Respiratory Tract Infections
Urinary Tract Infections
Behavioral: Antibiotic prescription feedback
Behavioral: No Feedback

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Health Services Research
Official Title: Routine Prescription Feedback and Peer Comparison to Lower Antibiotic Prescriptions in Primary Care - a Pragmatic Randomised Controlled Trial

Resource links provided by NLM:


Further study details as provided by University Hospital, Basel, Switzerland:

Primary Outcome Measures:
  • Prescription rate of antibiotics as defined daily doses (DDD) per 100 consultations [ Time Frame: at 12 and 24 months ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Costs-savings from the intervention [ Time Frame: at 24 months ] [ Designated as safety issue: No ]
  • Rate of physicians rating that the continuous update on antibiotic prescription data is useful [ Time Frame: at 24 months ] [ Designated as safety issue: No ]
  • Percentage of prescriptions fulfilling disease-specific quality indicators for outpatient antibiotic criteria by the European Surveillance of Antimicrobial Consumption (ESAC). [ Time Frame: at 24 months ] [ Designated as safety issue: No ]
  • Number of logins into the web-application [ Time Frame: at 24 months ] [ Designated as safety issue: No ]

Estimated Enrollment: 2854
Study Start Date: October 2013
Estimated Study Completion Date: April 2015
Estimated Primary Completion Date: October 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
No feedback
Physicians in the control group will only be monitored for their antibiotic prescription rates (Physicians are unaware of the trial).
Behavioral: No Feedback
Physicians in the control group will only be monitored for their antibiotic prescription rates (Physicians are unaware of the trial)
Other Name: Controls
Experimental: Antibiotic prescription feedback
Physicians receive quarterly electronic feedback on their antibiotic prescriptions
Behavioral: Antibiotic prescription feedback
Monthly postal and electronic feedback on antibiotic prescription rates
Other Name: Active physician benchmarking

Detailed Description:

Background: Excessive use of antibiotics may lead to unnecessary adverse events and raise the emergence of bacterial resistance, an increasingly serious problem in Europe. In absolute terms most antibiotics are prescribed in primary care with considerable unexplained variation of antibiotic use indicating the need for further important improvement of prescription practice in Switzerland.

Aim: To evaluate the effect of a continuous postal and web-based feedback and peer comparison system of individual antibiotic prescription rates on the prescription behaviour of primary care physicians in Switzerland.

Design: Randomized, controlled, pragmatic intervention trial. Setting: Primary care providers of Switzerland above the median of antibiotic prescription rates.

Population: Primary care physicians caring for patients enlisted with social health insurance companies that provide invoice data to the SANTÉSUISSE DATENPOOL AND TARIFPOOL.

Endpoints: Primary endpoint: Prescription rate of antibiotics as defined daily doses (DDD) per 100 consultations at 12 and 24 months. Secondary endpoints: Costs-savings from the intervention, acceptability of the program, percentage of prescriptions fulfilling disease-specific quality indicators for outpatient antibiotic criteria by the European Surveillance of Antimicrobial Consumption (ESAC).

Intervention: Quarterly postal and electronic feedback for 24 months on the crude number of antibiotics prescribed, a population adjusted benchmark-profile in comparison to other primary care physicians, and evidence-based guidelines for the use of antibiotics in primary care. Physicians in the control group receive no information.

Variables and measurement: Rates of antibiotic prescriptions overall and per drug class (DDD), cost of prescribed drugs and the intervention program; number of web-application logins and participation cancellations, and - in a sub-sample - number of prescriptions fulfilling disease-specific quality indicators for outpatient antibiotic criteria (ESAC).

Expected results: We expect a 5% reduction of antibiotic prescription rates between the intervention and control groups after 12 months with an assumed participation rate (at least one web-access) and return of acceptance questionnaire of 30%. We expect that the intervention program will be cost-saving. ESAC quality indicators will be a useful tool for monitoring the quality of antibiotic prescription in ambulatory care in Switzerland.

Analyses: Analysis will be done by intention to treat principles. We will use linear regression analysis to determine the difference in antibiotic prescriptions between the intervention and the control group with appropriate adjustment for the case mix of patient populations and self-dispensation. Based on outpatient data of 2009 from the Helsana insurance and conservative effect estimates a sample-size of 1427 physicians each for the intervention and control group is planned.

Significance: This trial will investigate if a repeated feedback system results in a long-term reduction of antibiotic prescription practices. In addition, the feasibility of a web-based interface as communication tool to primary care physicians will be assessed. If effective, the system could be easily employed for other interventions as well.

  Eligibility

Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Board certified physicians with a certificate from the Swiss Medical Association (Facharzttitel' General Internal Medicine, Subspecialities in Internal Medicine, Paediatrics) with an own ZAHLSTELLENREGISTER NUMBER (Konkordatsnummer).
  • At least 100 patients enlisted with the specified social health insurance providers (SANTÉSUISSE DATENPOOL AND TARIFPOOL). (to avoid classifying physicians as high prescribers who only see a small number of patients and describe antibiotics to many of them)
  • Prescription-rates of antibiotics (DDD per 100 consultations) - that are prescribed to patients enlisted with the specified social health insurance providers (SANTÉSUISSE TARIFPOOL)
  • are in the upper median of the prescription number distribution in the year prior to the start of the trial.

Exclusion Criteria:

  • Physicians with no own "Zentralstellenregister" (ZSR) number (practice fellows or substitutes, medical trainees in general practices).
  • Physicians working in institutions without own but with institutional ZSR NUMBER (ambulatory care facilities of University Hospitals, permanence, practices or Health Maintenance Organisation (HMO) with group ZSR number).
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01773824

Contacts
Contact: Heiner C Bucher, Prof Dr med +41 (0)61 265-3100 bucherh@uhbs.ch

Locations
Switzerland
Switzerland Recruiting
Basel, Switzerland
Contact: Heiner C Bucher, Prof Dr med    +41 61 265 3100    bucherh@uhbs.ch   
Principal Investigator: Heiner C Bucher, Prof Dr med         
Sponsors and Collaborators
University Hospital, Basel, Switzerland
Swiss National Science Foundation
Investigators
Principal Investigator: Heiner C Bucher, Prof Dr med Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel
Principal Investigator: Andreas Widmer, Prof Dr med Klinik für Infektiologie und Spitalhygiene, University Hospital Basel
Principal Investigator: Andreas Zeller, PD Dr med Institut für Hausarztmedizin, University of Basel
  More Information

Additional Information:
No publications provided

Responsible Party: University Hospital, Basel, Switzerland
ClinicalTrials.gov Identifier: NCT01773824     History of Changes
Other Study ID Numbers: USB-2012-074
Study First Received: August 24, 2012
Last Updated: August 19, 2014
Health Authority: Switzerland: Ethikkommission
Switzerland: Laws and standards

Keywords provided by University Hospital, Basel, Switzerland:
antibiotic
prescription rate

Additional relevant MeSH terms:
Infection
Communicable Diseases
Urinary Tract Infections
Respiratory Tract Infections
Urologic Diseases
Respiratory Tract Diseases
Anti-Bacterial Agents
Antibiotics, Antitubercular
Anti-Infective Agents
Therapeutic Uses
Pharmacologic Actions
Antitubercular Agents

ClinicalTrials.gov processed this record on September 18, 2014