Evaluation of an Educational Intervention on Antibiotics in Dental Care
NCT ID: NCT07016217
Last Updated: 2025-06-11
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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ACTIVE_NOT_RECRUITING
NA
3498 participants
INTERVENTIONAL
2023-05-15
2027-05-15
Brief Summary
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The main research question is:
Did the prescribing Portraits and Therapeutics Letter lead to a change in clindamycin prescribing as a proportion of total antibiotic prescribing by dentists in British Columbia.
Study participants are dentists actively practicing in British Columbia. Participants were randomized to 3 study arms to received different combinations of one of two versions of the individual prescribing Portraits and a Therapeutics Letter in Early or Delayed Groups. Two versions of the prescribing Portrait were used: a "plain" version and a "complete" version, which included an additional section with self-reflection questions for clinicians.
Using administrative health data, the prescribing of those in different combinations of materials in the Early Group will be compared to those in the Delayed Group to estimate the impact of the materials on prescribing by the dentists.
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Detailed Description
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Based in British Columbia, Canada, the Therapeutics Initiative's Portrait program provides physicians, and other health professionals, with individualized prescribing data compared with their peers, paired with evidence-based messaging, and a concise statement summarizing the desired change in prescribing behavior. The Portrait program implements a series of pragmatic trials to improve prescribing where clinicians are randomized into an early intervention and a delayed control group.
This study is a randomized trial examining the impact of prescribing Portraits on antibiotic prescribing by dentists in British Columbia. The Portrait title is "Which antibiotics do you prescribe for dental infections?" and is accompanied by a Therapeutics Letter entitled "Rethink Clindamycin for Dental Patient Safety." The materials were developed in collaboration with the BC Centre for Disease Control (BCCDC) and the BC College of Oral Health Professionals (BCCOHP).
When dentists prescribe antibiotics like clindamycin for dental infections, they often do so with the intention of combating bacterial growth. However, clindamycin come with a set of risks, notably the potential for Clostridium difficile infection (C. diff). This bacterium can proliferate in the gut when the normal balance of bacteria is disrupted by antibiotics, leading to symptoms ranging from mild diarrhea to severe colitis and life-threatening complications.
The main prescribing message for the dental Portrait is "clindamycin should not be used routinely for prophylaxis or management of dental infections." The Portrait has two different formats. The "plain" version includes the main message, prescriber's data (compare to optimal prescribing), and references. The "complete" version includes an additional series of self-reflection questions.
3498 dentists in British Columbia were randomized into three arms/groups (1166 in each group). For the Early mailing in Oct 2023, Arm A received the "plain" Portrait with a Therapeutics Letter; Arm B received a "complete" Portrait with a Letter, and Arm C received nothing. For the delayed mailing (April 2024), Arm A received the "complete" Portrait and Letter, Arm B received nothing, and Arm C received the "plain" Portrait and Letter.
The objective was to estimate the impact of the interventions (plain version of Portrait + Therapeutics Letter; Complete version of the Portrait + Therapeutics Letter; repeat messages) on prescribing of antibiotic medications by dentists in British Columbia.
The analysis will identify:
* Baseline characteristics: Physicians and patients by study group (age, age groups, and sex).
* Primary outcome: The change in clindamycin prescribing as a proportion of total antibiotic prescribing associated with the Portraits and Therapeutics Letter.
The investigators will identify the difference in the number of new starts of clindamycin after versus before the Early mailing date. New starters of clindamycin are defined as no antibiotic prescribed by any dentist in the previous year. Investigators will then calculate the mean difference among dentists in each of the comparison groups by estimating the odds ratio: adjust for clustering using GEE, with an interaction term between the randomization group id and time period, and with an independent correlation structure. Analysis assumes a normal distribution to derive confidence intervals. The difference between the comparison groups will be the estimated impact of the portrait.
Analysis will be conducted using secondary data from administrative databases from the BC Ministry of Health (under an Information Sharing Agreement). The data are patient level and include anonymized information about demographics, health costs, BC Medical Services Plan clinician services data, BC PharmaNet data (prescription drug dispensing at community pharmacies), client roster. The data do not include personally identifiable patient information.
Conditions
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Study Design
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RANDOMIZED
SEQUENTIAL
For the Early mailing on Oct 13, 2023, Arm A/Group 1 received the "plain" Portrait with a Therapeutics Letter; Arm B/Group 2 received a "complete" Portrait with a Letter, and Arm C/ Group 3 received nothing (control group). For the delayed mailing (April 24, 2024), Arm A/Group 1 received the "complete" Portrait and Letter, Arm B/Group 2 received nothing, and Arm C/ Group 3 received the "plain" Portrait and Letter.
HEALTH_SERVICES_RESEARCH
SINGLE
Study Groups
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Arm A (Group 1) - Portrait + Letter
This group received the "plain" Portrait with a Therapeutics Letter in the Early mailing (Oct 13, 2023), and received the "complete" Portrait with a Therapeutics Letter in the Delayed mailing (April 24, 2024).
Early Plain Portrait and Letter
In the context of audit and feedback interventions, the prescribing Portrait is a document produced by the Therapeutics Initiative that provides personalized prescribing feedback for clinicians in British Columbia. Portraits are used as a practice resource tool for reflection on prescribing or test-ordering patterns.
The Portraits provide data of individual prescribing along with evidence-based benchmarks or targets. The "plain" Portrait includes the main message, prescriber's data (compare to optimal prescribing, with or without information on BC mean/median). Prescribers are also given access to a succinct review of the best available evidence on the topic and recommendations for future action in the Therapeutics Letter, a standalone publication that details the evidence for the recommended practice in a brief and practical manner, with references.
Delayed Complete Portrait
Delayed "complete" Portrait and Letter (as described)
Arm B (Group 2) - Portrait + Letter
This group received the "complete" Portrait with a Therapeutics Letter in the Early mailing (Oct 13, 2023), and received nothing in the Delayed mailing (April 24, 2024).
Early Complete Portrait and Letter
In the context of audit and feedback interventions, the prescribing Portrait is a document produced by the Therapeutics Initiative that provides personalized prescribing feedback for clinicians in British Columbia. Portraits are used as a practice resource tool for reflection on prescribing or test-ordering patterns.
The Portraits provide data of individual prescribing along with evidence-based benchmarks or targets. The "complete" Portrait includes the main message, prescriber's data (compare to optimal prescribing, with or without information on BC mean/median) and a series of self-reflection questions. Prescribers are also given access to a succinct review of the best available evidence on the topic and recommendations for future action in the Therapeutics Letter, a standalone publication that details the evidence for the recommended practice in a brief and practical manner, with references.
No intervention
To measure the impact of the interventions, Arm C (Group 3) will receive no intervention in the Early mailing and Arm B (Group 2) will receive no intervention in the Delayed mailing.
Arm C (Group 3) - Control
This group received nothing in the Early mailing (Oct 13, 2023) and received the "plain" Portrait with a Therapeutics Letter in the Delayed mailing (April 24, 2024).
No intervention
To measure the impact of the interventions, Arm C (Group 3) will receive no intervention in the Early mailing and Arm B (Group 2) will receive no intervention in the Delayed mailing.
Delayed Plain Portrait and Letter
Delayed "plain" Portrait and Letter (as described)
Interventions
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Early Plain Portrait and Letter
In the context of audit and feedback interventions, the prescribing Portrait is a document produced by the Therapeutics Initiative that provides personalized prescribing feedback for clinicians in British Columbia. Portraits are used as a practice resource tool for reflection on prescribing or test-ordering patterns.
The Portraits provide data of individual prescribing along with evidence-based benchmarks or targets. The "plain" Portrait includes the main message, prescriber's data (compare to optimal prescribing, with or without information on BC mean/median). Prescribers are also given access to a succinct review of the best available evidence on the topic and recommendations for future action in the Therapeutics Letter, a standalone publication that details the evidence for the recommended practice in a brief and practical manner, with references.
Early Complete Portrait and Letter
In the context of audit and feedback interventions, the prescribing Portrait is a document produced by the Therapeutics Initiative that provides personalized prescribing feedback for clinicians in British Columbia. Portraits are used as a practice resource tool for reflection on prescribing or test-ordering patterns.
The Portraits provide data of individual prescribing along with evidence-based benchmarks or targets. The "complete" Portrait includes the main message, prescriber's data (compare to optimal prescribing, with or without information on BC mean/median) and a series of self-reflection questions. Prescribers are also given access to a succinct review of the best available evidence on the topic and recommendations for future action in the Therapeutics Letter, a standalone publication that details the evidence for the recommended practice in a brief and practical manner, with references.
No intervention
To measure the impact of the interventions, Arm C (Group 3) will receive no intervention in the Early mailing and Arm B (Group 2) will receive no intervention in the Delayed mailing.
Delayed Plain Portrait and Letter
Delayed "plain" Portrait and Letter (as described)
Delayed Complete Portrait
Delayed "complete" Portrait and Letter (as described)
Eligibility Criteria
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Inclusion Criteria
* Dentists in BC included in randomization groups 1-3 with at least 10 prescription orders filled for antibiotics in 2022
* Patients aged \>16
* Patient prescribed antibiotic therapy by a BC dentist during, before, or after periods; Anatomical Therapeutic Chemical (ATC) classes J01
* Patient was enrolled in MSP at least 1 month before the prescription
Exclusion Criteria
* Dentists with fewer than 10 prescription orders filled in 2022
* Patients used antibiotics in the last 14 days (prescribed by any prescriber, not only dentists) before the prescription; and
* Federally insured BC residents and beneficiaries of the First Nations Health Benefit Plan; we were not given permission to use these data in our evaluation
16 Years
ALL
No
Sponsors
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Ministry of Health, British Columbia
OTHER_GOV
British Columbia Centre for Disease Control
OTHER_GOV
British Columbia College of Oral Health Professionals
UNKNOWN
University of British Columbia
OTHER
Responsible Party
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Colin Dormuth
Associate Professor
Principal Investigators
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Colin Dormuth, ScD
Role: PRINCIPAL_INVESTIGATOR
University of British Columbia
Locations
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Therapeutics Initiative - Dept of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia
Vancouver, British Columbia, Canada
Countries
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Other Identifiers
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H23-01507
Identifier Type: -
Identifier Source: org_study_id
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