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

NCT ID: NCT05044052

Last Updated: 2023-01-05

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 3379 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2021-12-15
• Study Completion Date: 2022-12-15

Brief 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.

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.

Detailed Description

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.

Conditions

Infection

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: DOUBLE

Study Groups

Intervention Group - Viral prescription pad + emphasis

Physicians in this group will receive their usual MyPractice: Primary Care report from Ontario Health. This report will include antibiotic prescribing indicators as well as a link to the viral prescription pad. As part of the intervention, these physicians will also receive additional emphasis on the viral prescription pad by 1) encouraging it in the dissemination email of the MyPractice feedback report, and (2) mailing a paper version of the viral prescription pad with instructions on embedding the viral prescription pad into the recipient's EMR.

Group Type: EXPERIMENTAL

Emphasis on the Choosing Wisely Viral Prescription Pad

Intervention Type: 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.

Control group

Physicians in this group will receive their usual MyPractice: Primary Care report from Ontario Health. This report will include antibiotic prescribing indicators as well as a link to the viral prescription pad. This group will not receive any additional emphasis on the viral prescription pad and will not receive a paper copy in the mail.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Emphasis on the Choosing Wisely Viral Prescription Pad

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.

Intervention Type: BEHAVIORAL

Eligibility Criteria

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

• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Ontario Agency for Health Protection and Promotion

OTHER_GOV

Sponsor Role: collaborator

College of Family Physicians of Canada

OTHER

Sponsor Role: collaborator

Canadian Institutes of Health Research (CIHR)

OTHER_GOV

Sponsor Role: collaborator

Women's College Hospital

OTHER

Sponsor Role: lead

Responsible Party

Noah Ivers

Family Physician, Canada Research Chair (Tier 2) in Implementation of Evidence Based Practice

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Noah M Ivers, MD

Role: PRINCIPAL_INVESTIGATOR

Women's College Hospital

Locations

Women's College Hospital

Toronto, Ontario, Canada

Countries

Canada

References

Shuldiner J, Lacroix M, Saragosa M, Reis C, Schwartz KL, Gushue S, Leung V, Grimshaw J, Silverman M, Thavorn K, Leis JA, Kidd M, Daneman N, Tradous M, Langford B, Morris AM, Lam J, Garber G, Brehaut J, Taljaard M, Greiver M, Ivers NM. Process evaluation of two large randomized controlled trials to understand factors influencing family physicians' use of antibiotic audit and feedback reports. Implement Sci. 2024 Sep 16;19(1):65. doi: 10.1186/s13012-024-01393-5.

Reference Type: DERIVED

PMID: 39285305 (View on PubMed)

Shuldiner J, Schwartz KL, Langford BJ, Ivers NM; Ontario Healthcare Implementation Laboratory study team. Optimizing responsiveness to feedback about antibiotic prescribing in primary care: protocol for two interrelated randomized implementation trials with embedded process evaluations. Implement Sci. 2022 Feb 14;17(1):17. doi: 10.1186/s13012-022-01194-8.

Reference Type: DERIVED

PMID: 35164805 (View on PubMed)

Other Identifiers

2020-0024-E (OH Trial)

Identifier Type: -

Identifier Source: org_study_id