Electronic Medical Records to Increase Adherence to the Choosing Wisely Recommendations

NCT ID: NCT05385445

Last Updated: 2022-05-23

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 239 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2016-01-01
• Study Completion Date: 2019-12-31

Brief Summary

Audit and Feedback (A&F), a strategy aimed at promoting modified practice through performance feedback, is a method to change provider behaviour and reduce unnecessary medical services. This study aims to assess the use of A&F to change:

1. antibiotic prescribing for viral infections

2. antipsychotic prescribing to patients with dementia

3. routine measure of vitamin D in low risk adults

4. annual screening blood tests (without direct indication by the risk profile of the patient)

Detailed Description

The investigators conducted a clustered randomized trial of primary care providers in Manitoba, Canada participating in the Manitoba Primary Care Research Network (MaPCReN) to assess the impact of A&F interventions to change prescribing and screening rates.

In January 2016, MaPCReN included 239 providers in 46 practices across Manitoba, representing ~20% of Manitoba primary care providers. MaPCReN recruits consenting primary care providers (family physicians, nurse practitioners and community pediatricians) that receive semi-annual feedback reports for practice reflection and quality improvement. Feedback reports provide practice-level details including disease prevalence and clinical characteristics of patients, reported in comparison to other providers at the same practice, health region and provincially

Investigators implemented an A&F cycle reporting on practice behaviours related to four Choosing Wisely Canada (CWC) recommendations.

A) "Don't use antibiotics for upper respiratory infections that are likely viral in origin, such as influenza-like illness, or self-limiting, such as sinus infections of less than seven days of duration." • Bacterial infections of the respiratory tract are rare and usually only secondary complications from initial viral infections. Antibiotics are rarely indicated for upper respiratory illness and patients may suffer adverse effects from antibiotics.

B) Don't routinely measure Vitamin D in low risk adults.

• Routine supplementation of vitamin D is recommended for people living in Northern climates regardless of measured laboratory levels. There is no indication for ordering vitamin D unless a patient is suffering severe renal or metabolic disease.

C) Don't do annual screening blood tests unless directly indicated by the risk profile of the patient.

• There is minimal value in ordering routine blood tests in asymptomatic patients and in fact some "routine" screening tests such as prostate-specific antigen (PSA) is in fact recommended against due to the likelihood of producing false positive results. This may lead to additional and unnecessary testing.

D) Don't prescribe antipsychotics to treat behavioural and psychological symptoms of dementia.

• There are some instances where patients with behavioural symptoms of dementia require antipsychotic medicines although these instances are rare. These medicines should be used judiciously given for this indication because they provide limited benefit and may cause serious side effects including premature death

MaPCReN personnel randomly assigned numbers to clinics for randomization. Number of physicians practicing at each clinic was controlled during randomization.

The intervention "Group 1" received the standard feedback report with a one-page summary of the CWC recommendations of interest. Group 1 did not receive any data specific to their prescribing. Intervention "Group 2" received the standard feedback report, CWC recommendation summary and practice-specific data related to their prescribing rates for the CWC recommendations of interest, compared to rates for other providers at their clinic, in their health region and in the province. The control group received the standard feedback report with no information related to CWC.

The A&F intervention took place between January 2016 and January 2017. Retrospective Electronic Medical Record (EMR) data from the MaPCReN repository was assessed between January 2014-December 2019 to assess changes in prescribing rates during and immediately following the A&F intervention (2016/17), as well as assess continued change in practice after the A&F (2018/19) compared to prescribing rates prior to the A&F (2014/15). There were seven clinics not included in the 2018/19 analysis due to a change in EMR vendor that may have compromised data quality.

Conditions

Dementia; Viral Infection; Vitamin D Deficiency

Study Design

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

Study Groups

Audit and Feedback Group 1

The intervention "Group 1" received the standard feedback report with a one-page summary of the CWC recommendations of interest. Group 1 did not receive any data specific to their prescribing.

Group Type: EXPERIMENTAL

Audit and Feedback

Intervention Type: BEHAVIORAL

The investigators conducted a clustered randomized trial of primary care providers in Manitoba, Canada participating in the Manitoba Primary Care Research Network (MaPCReN) to assess the impact of Audit \& Feedback interventions to change prescribing and laboratory ordering.

Audit and Feedback Group 2

Intervention "Group 2" received the standard feedback report, CWC recommendation summary and practice-specific data related to their prescribing rates for the CWC recommendations of interest, compared to rates for other providers at their clinic, in their health region and in the province.

Group Type: EXPERIMENTAL

Audit and Feedback

Intervention Type: BEHAVIORAL

The investigators conducted a clustered randomized trial of primary care providers in Manitoba, Canada participating in the Manitoba Primary Care Research Network (MaPCReN) to assess the impact of Audit \& Feedback interventions to change prescribing and laboratory ordering.

Control

The control group received the standard feedback report with no information related to CWC.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Audit and Feedback

The investigators conducted a clustered randomized trial of primary care providers in Manitoba, Canada participating in the Manitoba Primary Care Research Network (MaPCReN) to assess the impact of Audit \& Feedback interventions to change prescribing and laboratory ordering.

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

• All primary care providers participating in the Manitoba Primary Care Research Network (MaPCReN), the Manitoba practice-based network of the Canadian Primary Care Sentinel Surveillance Network.

Exclusion Criteria

• Primary care providers not participating in MaPCReN

• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Manitoba Medical Service Foundation

OTHER

Sponsor Role: collaborator

University of Manitoba

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Locations

University of Manitoba, Department of Family Medicine

Winnipeg, Manitoba, Canada

Countries

Canada

References

Singer A, Kosowan L, Katz A, Jolin-Dahel K, Appel K, Lix LM. Prescribing and testing by primary care providers to assess adherence to the Choosing Wisely Canada recommendations: a retrospective cohort study. CMAJ Open. 2018 Dec 10;6(4):E603-E610. doi: 10.9778/cmajo.20180053. Print 2018 Oct-Dec.

Reference Type: BACKGROUND

PMID: 30530720 (View on PubMed)

Singer A, Kosowan L, Abrams EM, Katz A, Lix L, Leong K, Paige A. Implementing an audit and feedback cycle to improve adherence to the Choosing Wisely Canada recommendations: clustered randomized trail. BMC Prim Care. 2022 Nov 26;23(1):302. doi: 10.1186/s12875-022-01912-7.

Reference Type: DERIVED

PMID: 36435746 (View on PubMed)

Other Identifiers

HS19281(H2016:022)

Identifier Type: -

Identifier Source: org_study_id