Do Fair Comparisons or Harms Data Increase Responsiveness to Feedback About Antibiotic Prescribing: 2x2 Factorial Trial - Trial NCT04594200

Timeline & Enrollment

Primary Outcome

Antibiotic prescribing rate

Summary

Antibiotic overuse is common and antibiotic prescribing contributes to rising rates of
 antimicrobial resistance. Primary care physicians prescribe the majority of all antibiotics
 and there is large inter-physician variability in prescribing that cannot be explained by
 differences in patient populations.
 
 Peer comparison audit and feedback (A&F) can act as an effective behavioural intervention to
 reduce unnecessary antibiotic use. The range of effects seen in prior A&F trials could be
 attributed, at least in part, to differences in the way the feedback interventions were
 designed. In fall 2018, the investigators conducted an audit and feedback trial of mailed
 letters to 3500 family physicians in Ontario who prescribe the highest volume of antibiotics
 [NCT03776383]. While effective, family physicians questioned the credibility of the report in
 terms of its ability to fairly account for their practice size and population.
 
 In Ontario, A&F is routinely offered to primary care providers from a variety of sources.
 Ontario Health - an agency created by the Government of Ontario - provides A&F via email to
 physicians who voluntarily sign up for their MyPractice reports. These are multi-topic
 reports with aggregated (physician-level) data. As of November 2021, the MyPractice reports
 for family physicians will include data on antibiotic prescribing. To date, less than half of
 Ontario family physicians have signed up for the MyPractice reports from Ontario Health.
 
 For this study, the investigators will conduct a trial to investigate the effect of A&F in
 family physicians not already receiving A&F through a MyPractice: Primary Care report.
 Physicians who do not already receive antibiotic prescribing feedback through a MyPractice
 report will receive personalized antibiotic prescribing feedback through a letter mailed out
 from PHO. This large-scale evaluation provides an opportunity to evaluate not only whether
 A&F using such data is helpful in the post-covid context, but how best to design the A&F
 intervention and to explore why we observed (or not) changes in antibiotic prescribing.

ICD-10 Classifications