PDF(Pubmed)
Abstract：
To evaluate whether providing family physicians with feedback on their antibiotic prescribing compared with that of their peers reduces antibiotic prescriptions. To also identify effects on antibiotic prescribing from case-mix adjusted feedback reports and messages emphasising antibiotic associated harms.
Pragmatic, factorial randomised controlled trial.
Primary care physicians in Ontario, Canada PARTICIPANTS: All primary care physicians were randomly assigned a group if they were eligible and actively prescribing antibiotics to patients 65 years or older. Physicians were excluded if had already volunteered to receive antibiotic prescribing feedback from another agency, or had opted out of the trial.
A letter was mailed in January 2022 to physicians with peer comparison antibiotic prescribing feedback compared with the control group who did not receive a letter (4:1 allocation). The intervention group was further randomised in a 2x2 factorial trial to evaluate case-mix adjusted versus unadjusted comparators, and emphasis, or not, on harms of antibiotics.
Antibiotic prescribing rate per 1000 patient visits for patients 65 years or older six months after intervention. Analysis was in the modified intention-to-treat population using Poisson regression.
5046 physicians were included and analysed: 1005 in control group and 4041 in intervention group (1016 case-mix adjusted data and harms messaging, 1006 with case-mix adjusted data and no harms messaging, 1006 unadjusted data and harms messaging, and 1013 unadjusted data and no harms messaging). At six months, mean antibiotic prescribing rate was 59.4 (standard deviation 42.0) in the control group and 56.0 (39.2) in the intervention group (relative rate 0.95 (95% confidence interval 0.94 to 0.96). Unnecessary antibiotic prescribing (0.89 (0.86 to 0.92)), prolonged duration prescriptions defined as more than seven days (0.85 (0.83 to 0.87)), and broad spectrum prescribing (0.94 (0.92 to 0.95)) were also significantly lower in the intervention group compared with the control group. Results were consistent at 12 months post intervention. No significant effect was seen for including emphasis on harms messaging. A small increase in antibiotic prescribing with case-mix adjusted reports was noted (1.01 (1.00 to 1.03)).
Peer comparison audit and feedback letters significantly reduced overall antibiotic prescribing with no benefit of case-mix adjustment or harms messaging. Antibiotic prescribing audit and feedback is a scalable and effective intervention and should be a routine quality improvement initiative in primary care.
ClinicalTrials.gov NCT04594200.
Pragmatic, factorial randomised controlled trial.
Primary care physicians in Ontario, Canada PARTICIPANTS: All primary care physicians were randomly assigned a group if they were eligible and actively prescribing antibiotics to patients 65 years or older. Physicians were excluded if had already volunteered to receive antibiotic prescribing feedback from another agency, or had opted out of the trial.
A letter was mailed in January 2022 to physicians with peer comparison antibiotic prescribing feedback compared with the control group who did not receive a letter (4:1 allocation). The intervention group was further randomised in a 2x2 factorial trial to evaluate case-mix adjusted versus unadjusted comparators, and emphasis, or not, on harms of antibiotics.
Antibiotic prescribing rate per 1000 patient visits for patients 65 years or older six months after intervention. Analysis was in the modified intention-to-treat population using Poisson regression.
5046 physicians were included and analysed: 1005 in control group and 4041 in intervention group (1016 case-mix adjusted data and harms messaging, 1006 with case-mix adjusted data and no harms messaging, 1006 unadjusted data and harms messaging, and 1013 unadjusted data and no harms messaging). At six months, mean antibiotic prescribing rate was 59.4 (standard deviation 42.0) in the control group and 56.0 (39.2) in the intervention group (relative rate 0.95 (95% confidence interval 0.94 to 0.96). Unnecessary antibiotic prescribing (0.89 (0.86 to 0.92)), prolonged duration prescriptions defined as more than seven days (0.85 (0.83 to 0.87)), and broad spectrum prescribing (0.94 (0.92 to 0.95)) were also significantly lower in the intervention group compared with the control group. Results were consistent at 12 months post intervention. No significant effect was seen for including emphasis on harms messaging. A small increase in antibiotic prescribing with case-mix adjusted reports was noted (1.01 (1.00 to 1.03)).
Peer comparison audit and feedback letters significantly reduced overall antibiotic prescribing with no benefit of case-mix adjustment or harms messaging. Antibiotic prescribing audit and feedback is a scalable and effective intervention and should be a routine quality improvement initiative in primary care.
ClinicalTrials.gov NCT04594200.
摘要：
目的：评估向家庭医生提供抗生素处方反馈与同行相比是否能减少抗生素处方。还从病例组合调整后的反馈报告和强调抗生素相关危害的信息中确定对抗生素处方的影响。
方法：务实，阶乘随机对照试验。
方法：安大略省的初级保健医生，加拿大参与者：如果所有初级保健医生符合条件，他们将被随机分配一组，并积极为65岁或以上的患者开抗生素。如果医生已经自愿接受另一个机构的抗生素处方反馈，则被排除在外。或者选择退出审判.
方法：2022年1月向医生邮寄了一封信，与未收到信件的对照组相比，同行比较抗生素处方反馈（4：1分配）。干预组在2x2阶乘试验中进一步随机分组，以评估病例组合调整后与未调整后的比较，和强调，或者不是，抗生素的危害。
方法：在干预后6个月，65岁或以上的患者每1000名患者就诊的抗生素处方率。使用泊松回归对改良的意向治疗人群进行分析。
结果：纳入并分析了5046名医生：对照组1005名，干预组4041名（1016个病例组合调整数据和危害信息，1006，具有大小写混合调整后的数据，没有危害消息传递，1006未调整的数据和危害消息传递，和1013个未调整的数据，没有危害消息传递)。六个月的时候，对照组和干预组的平均抗生素处方率分别为59.4(标准差42.0)和56.0(39.2)(相对率0.95(95%置信区间0.94~0.96).不必要的抗生素处方（0.89（0.86至0.92）），长期处方定义为超过7天(0.85(0.83至0.87))，与对照组相比，干预组的广谱处方（0.94（0.92至0.95））也显着降低。结果在干预后12个月是一致的。没有看到显着效果，包括强调危害信息。注意到抗生素处方与病例混合调整报告的小幅增加（1.01（1.00至1.03））。
结论：同行比较审核和反馈信显著减少了总体抗生素处方，没有病例组合调整或损害信息传递的益处。抗生素处方审核和反馈是一种可扩展且有效的干预措施，应成为初级保健中的常规质量改进举措。
背景：ClinicalTrials.govNCT04594200。
方法：务实，阶乘随机对照试验。
方法：安大略省的初级保健医生，加拿大参与者：如果所有初级保健医生符合条件，他们将被随机分配一组，并积极为65岁或以上的患者开抗生素。如果医生已经自愿接受另一个机构的抗生素处方反馈，则被排除在外。或者选择退出审判.
方法：2022年1月向医生邮寄了一封信，与未收到信件的对照组相比，同行比较抗生素处方反馈（4：1分配）。干预组在2x2阶乘试验中进一步随机分组，以评估病例组合调整后与未调整后的比较，和强调，或者不是，抗生素的危害。
方法：在干预后6个月，65岁或以上的患者每1000名患者就诊的抗生素处方率。使用泊松回归对改良的意向治疗人群进行分析。
结果：纳入并分析了5046名医生：对照组1005名，干预组4041名（1016个病例组合调整数据和危害信息，1006，具有大小写混合调整后的数据，没有危害消息传递，1006未调整的数据和危害消息传递，和1013个未调整的数据，没有危害消息传递)。六个月的时候，对照组和干预组的平均抗生素处方率分别为59.4(标准差42.0)和56.0(39.2)(相对率0.95(95%置信区间0.94~0.96).不必要的抗生素处方（0.89（0.86至0.92）），长期处方定义为超过7天(0.85(0.83至0.87))，与对照组相比，干预组的广谱处方（0.94（0.92至0.95））也显着降低。结果在干预后12个月是一致的。没有看到显着效果，包括强调危害信息。注意到抗生素处方与病例混合调整报告的小幅增加（1.01（1.00至1.03））。
结论：同行比较审核和反馈信显著减少了总体抗生素处方，没有病例组合调整或损害信息传递的益处。抗生素处方审核和反馈是一种可扩展且有效的干预措施，应成为初级保健中的常规质量改进举措。
背景：ClinicalTrials.govNCT04594200。
