Routine Prescription Feedback and Peer Comparison to Lower Antibiotic Prescriptions in Primary Care
|Upper Respiratory Tract Infections Urinary Tract Infections||Behavioral: Antibiotic prescription feedback Behavioral: No Feedback|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (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|
- Prescription rate of antibiotics as defined daily doses (DDD) per 100 consultations [ Time Frame: at 12 and 24 months ]
- Costs-savings from the intervention [ Time Frame: at 24 months ]
- Rate of physicians rating that the continuous update on antibiotic prescription data is useful [ Time Frame: at 24 months ]
- 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 ]
- Number of logins into the web-application [ Time Frame: at 24 months ]
|Study Start Date:||October 2013|
|Study Completion Date:||December 2015|
|Primary Completion Date:||December 2015 (Final data collection date for primary outcome measure)|
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
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.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01773824
|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|