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Published on: August 30, 2018
Spillover From an Intervention on Antibiotic Prescribing for Family Physicians: A Post Hoc Secondary Analysis of a
Kiran Saqib1, Noah Ivers2,3,4, Kevin A Brown1,2,5
1Public Health Ontario, Toronto, Ontario, Canada.
Importance:
Antibiotic audit and feedback is effective at reducing antibiotic prescribing in primary care.
Objective:
To evaluate the spillover of an audit-and-feedback intervention originally targeted at patients aged 65 years or older on a broader population of all age groups.
Design, Setting, And Participants:
This is a post hoc secondary analysis of a randomized clinical trial that was conducted among primary care physicians in Ontario, Canada. Physicians were randomized in a 4:1 allocation, with a peer comparison feedback letter sent in January 2022. Physicians in the control group received no letter. The randomized clinical trial was conducted from January 2021 to December 2022, and this analysis was performed from March to June 2024.
Exposure:
A mailed antibiotic prescribing feedback letter, with peer comparison.
Main Outcomes And Measures:
The primary outcome was the total number of antibiotic prescriptions by physicians at 12 months after the intervention for patients of all ages. This analysis was conducted utilizing a different administrative data source than the original trial; this source contained antibiotic prescription counts for all patient age groups. Data were analyzed with Poisson regression models, adjusted for baseline prescribing and stratified by patient age and sex.
Results:
Overall, 4964 of 5097 randomized physicians (97.4%) were included in this analysis. There were 3967 (74.5%) in the intervention group and 997 (25.5%) in the control group; 2766 physicians (55.7%) were male, and 2549 (51.3%) had been in practice for 25 years or more. The intervention group showed a reduction in antibiotic prescriptions at 12 months after intervention compared with the control group (adjusted rate ratio [aRR], 0.93; 95% CI, 0.93-0.94). Significant reductions were seen across all age and sex groups and for antibiotics typically used for respiratory infections. Additionally, the proportion of prescriptions exceeding 7 days decreased significantly in the intervention group (aRR, 0.82; 95% CI, 0.82-0.83).
Conclusions And Relevance:
In this post hoc secondary analysis of a randomized clinical trial of peer comparison antibiotic audit and feedback for physicians with data from patients aged 65 and older, the intervention group had a reduction in antibiotic prescriptions across all patient ages. These findings suggest that routinely collected administrative data can be effectively used for implementing and evaluating antibiotic audit and feedback, even when limited to older patients.
Trial Registration:
ClinicalTrials.gov Identifier: NCT04594200.
Insights
Antibiotic audit and feedback reduced overall antibiotic prescribing in primary care across all age groups. This intervention also decreased the duration of antibiotic prescriptions, demonstrating broad effectiveness.
Area of Science:
- Health Services Research
- Infectious Disease Epidemiology
- Primary Care Medicine
Background:
- Antibiotic stewardship programs are crucial for combating antimicrobial resistance.
- Audit and feedback interventions have shown promise in modifying physician prescribing behavior.
- Previous studies often focus on specific patient populations, necessitating research on broader applicability.
Purpose of the Study:
- To assess the impact of an audit and feedback intervention, initially targeting older adults, on antibiotic prescribing across all patient age groups.
- To evaluate the spillover effect of the intervention beyond the originally intended demographic.
Main Methods:
- A post hoc secondary analysis of a randomized clinical trial involving primary care physicians in Ontario, Canada.
- Physicians received mailed feedback letters comparing their antibiotic prescribing to peers (intervention) or received no feedback (control).
- Poisson regression models analyzed antibiotic prescription counts from administrative data for all patient ages, adjusted for baseline prescribing and stratified by age and sex.
Main Results:
- The intervention group demonstrated a significant reduction in antibiotic prescriptions at 12 months post-intervention (adjusted rate ratio [aRR], 0.93).
- Reductions in antibiotic prescribing were observed across all patient age and sex groups, including for respiratory infection treatments.
- The proportion of antibiotic prescriptions exceeding 7 days also significantly decreased in the intervention group (aRR, 0.82).
Conclusions:
- Audit and feedback interventions, even when initially targeted, can effectively reduce antibiotic prescribing across all patient demographics in primary care.
- Routinely collected administrative data are a viable resource for implementing and evaluating antibiotic stewardship interventions.
- The findings support the widespread application of audit and feedback for optimizing antibiotic use in primary care settings.
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