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OpenTrials
Completed

NCT Number: NCT05044052

Does Inclusion of Viral Prescription Pad Resources Increase Responsiveness to Feedback About Antibiotic Prescribing in Primary Care

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.

In Ontario, audit and feedback (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 adding viral prescription pad resources to family physician A&F received through a MyPractice: Primary Care report. This evaluation provides an opportunity to determine if the addition of this resource to an A&F intervention increases changes to antibiotic prescribing.

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Key information

Conditions

Infection Infections

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Women's College Hospital

Toronto, Ontario, M5G 1N8, Canada

About this study

This study will examine ways to optimize the effects of A&F for antibiotic prescribing in primary care. This study will aim to determine if emphasis (or not) on the use of a viral prescription pad developed by Choosing Wisely Canada (CWC) can help physicians act upon the feedback from their MyPractice report to reduce their antibiotic prescribing.

Antibiotic prescribing feedback within the multi-topic MyPractice: Primary Care report will be sent to family physicians who signed up for this program from Ontario Health. This report includes a link to the Choosing Wisely viral prescription pad. Physicians will be randomized to the control group or intervention group. Physicians in the intervention group will receive additional emphasis on the use of the viral prescription pad and will also have a paper copy of the prescription pad mailed to their practice.

One month after the initial intervention, participants will be invited to complete a process evaluation survey to determine why or why not the intervention worked and how individual factors can affect physician motivation, willingness, and ability to engage in new practices. Intervention participants will also be invited to take part in a process evaluation interview.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Family physicians who sign up for the MyPractice reports by September 2021

Exclusion criteria

  • Family physicians who did not sign up for the MyPractice reports by September 2021

Treatment and study plan

Emphasis on the Choosing Wisely Viral Prescription Pad

Behavioral

We will investigate the effects of emphasizing the use of materials developed by Choosing Wisely Canada (CWC) - namely the viral prescription pad - to help physicians act upon the feedback to reduce their prescribing.

Primary outcomes

  1. Antibiotic prescribing rate

    Time frame: 6 months

    Total number of antibiotic prescriptions per 1000 65+ patient visits

Secondary outcomes

  1. Proportion Antibiotic Rx with Prolonged Duration

    Time frame: 6 months

    Antibiotics prescribed for more than 7 days per episode

  2. Proportion Antibiotic Rx with Prolonged Duration

    Time frame: 12 months

    Antibiotics prescribed for more than 7 days per episode

  3. Antibiotic drug costs

    Time frame: 6 months

    Cost in CDN$

  4. Antibiotic drug costs

    Time frame: 12 months

    Cost in CDN$

  5. Antibiotics prescribed for viral infections

    Time frame: 6 months

    Total number of antibiotic rx per 1000 65+ patient visits for presumed viral condition (and thus likely unnecessary) based on administrative database diagnostic codes

  6. Antibiotics prescribed for viral infections

    Time frame: 12 months

    Total number of antibiotic rx per 1000 65+ patient visits for presumed viral condition (and thus likely unnecessary) based on administrative database diagnostic codes

  7. Total Antibiotic Days of Therapy

    Time frame: 6 months

    Total number DOTs per 1000 65+ patient visits

  8. Total Antibiotic Days of Therapy

    Time frame: 12 months

    Total number DOTs per 1000 65+ patient visits

  9. Proportion of broad spectrum antibiotic prescriptions

    Time frame: 6 months

    antibiotic prescriptions that are broad spectrum

  10. Proportion of broad spectrum antibiotic prescriptions

    Time frame: 12 months

    antibiotic prescriptions that are broad spectrum

Sponsors and collaborators

Lead sponsor

Women's College Hospital

Other

Collaborators

  • Canadian Institutes of Health Research (CIHR)
  • College of Family Physicians of Canada
  • Ontario Agency for Health Protection and Promotion

Registry information

Official study title

Do Peer-comparisons, Emphasis on Harms, and/or Inclusion of Viral Prescription Pad Resources Increase Responsiveness to Feedback About Antibiotic Prescribing in Primary Care: Protocol for Two Linked Trials With Embedded Process Evaluations (OH Trial)

Important dates

Study start
2021
Primary completion
2022
Study completion
2022
First posted
Sep 14, 2021
Registry last updated
Jan 5, 2023

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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