Peer Comparison Feedback As An Antimicrobial Prescribing Intervention To General Medicine Specialists

NCT ID: NCT07189364

Last Updated: 2025-09-23

Basic Information

• Recruitment Status: ENROLLING_BY_INVITATION
• Clinical Phase: NA
• Total Enrollment: 650 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-09-30
• Study Completion Date: 2027-04-30

Brief Summary

The purpose of this study is to evaluate the effect of a peer comparison feedback report, combined with a best practices toolkit, on the volume of antimicrobial use by general medicine physicians. The study also aims to understand the qualitative and quantitative impact of peer comparison feedback on antimicrobial prescribing in hospital.

This study will leverage data from GEMINI, a hospital research collaborative that collects administrative and clinical data from 30+ Ontario hospitals, to create these peer comparison feedback reports.

Detailed Description

Antimicrobial resistance (AMR) is a critical threat to human health, having led to the deaths of 14,000 people in Canada in 2018 and 1.25 million people globally in 2019. There has been limited success in overcoming AMR through developing new antimicrobials, primarily due to inadequate investment in new antimicrobial discovery, and economic and regulatory hurdles. Acquired resistance is also likely to occur as newer agents come to market. The World Health Organization and the Public Health Agency of Canada have identified overuse of antimicrobials as a primary ongoing driver of AMR. Therefore, optimizing antimicrobial use must be a cornerstone of our response to the AMR crisis.

Antimicrobial stewardship (AMS) interventions (activities designed to safely improve antimicrobial use) can lead to reductions in antimicrobial use, antimicrobial costs, hospital length of stay, and C. difficile rates. Previous work has demonstrated that audit and feedback with peer comparison in a primary care setting can lead to a clinically significant reduction in antimicrobial use, with no demonstrable safety concerns. For example, the study team previously tested a peer comparison letter to primary care providers in the highest quartile of antimicrobial prescribing across Ontario and found a clinically significant 4% relative reduction in total antimicrobial prescribing. This extrapolates to nearly 150,000 fewer prescriptions and drug-cost savings of $2.7 million annually for the province.

General medicine wards are an important target for antimicrobial stewardship efforts, as they care for the largest group of hospital inpatients, patients are often medically complex, and admissions are heterogeneous in condition/disease. However, physician-level prescribing data for hospitalized patients has historically been difficult to collect and attribute to a specific clinician, limiting rigorous evaluation. This trial will leverage GEMINI's pharmacy data to create physician-level peer-comparison reports for physicians practicing on general medical wards. Building on a previous CIHR-funded RCT led by Drs. Desveaux and Ivers, this trial will also develop a mixed methods process evaluation methodology to assess fidelity and mechanism of action.

Conditions

Antimicrobial Stewardship; Antimicrobial Drug Resistance

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: NONE

Study Groups

Intervention Group

The intervention group will receive an electronic peer-comparison feedback report on their antimicrobial prescribing practices and a knowledge toolkit about antimicrobial use, bundled as a single intervention.

Group Type: EXPERIMENTAL

Peer Comparison Feedback Report

Intervention Type: BEHAVIORAL

The intervention will be an electronic, individualized, peer-comparison feedback report on the participant's antimicrobial prescribing practices, combined with a knowledge toolkit focused on optimizing antimicrobial use.

Control Group

The control group will not receive a peer-comparison feedback report on their antimicrobial prescribing practices, or a knowledge toolkit on antimicrobial use.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Peer Comparison Feedback Report

The intervention will be an electronic, individualized, peer-comparison feedback report on the participant's antimicrobial prescribing practices, combined with a knowledge toolkit focused on optimizing antimicrobial use.

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

1. Patient-level: All adult inpatients (>=18 years of age) discharged within the baseline evaluation period and follow up period will be included in a physician report if they match the following criteria: a) Total in-hospital length of stay (LOS) is less than or equal to 14 days; b) and admitted to or discharged from a general medicine or hospitalist ward; c) admitted via the emergency department.

2. Physician-level: Physicians will be included if they have at least 50 hospitalizations attributed to them during the baseline period. Physicians who practice at multiple sites will only be included at the hospital with more encounters.

3. Hospital-level: In total, 29 teaching and community hospitals that provide data to GEMINI, with comprehensive geographic coverage of Ontario, will be included in this trial.

Exclusion Criteria

1. Patient-level: All data from ICU dates of care will be excluded from the trial (defined by ICU admission start and stop dates). All antimicrobial use data from ICU dates will be censored and excluded from attribution to GM physicians. Additionally, all patients with ICD-10-CA code Z51.5 for palliative care will be excluded owing to expected differences in antimicrobial management strategies.

3. Hospital-level: Two hospitals in the GEMINI network will be excluded from this trial due to their lack of GM wards (a cancer hospital and a COVID-19 reactivation hospital). Additionally, any hospitals in the GEMINI network that do not meet annual data quality standards for antimicrobial use or other data fields will not be included in the trial.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Canadian Institutes of Health Research (CIHR)

OTHER_GOV

Sponsor Role: collaborator

Sinai Health System

OTHER

Sponsor Role: collaborator

Unity Health Toronto

OTHER

Sponsor Role: collaborator

Fahad Razak

OTHER

Sponsor Role: lead

Responsible Party

Fahad Razak

MD, St. Michael's Hospital - Unity Health Toronto

Responsibility Role: SPONSOR_INVESTIGATOR

Principal Investigators

Fahad Razak, MD

Role: PRINCIPAL_INVESTIGATOR

St. Michael's Hospital - Unity Health Toronto

Locations

GEMINI Research Program

Toronto, Ontario, Canada

Countries

Canada

Other Identifiers

5327

Identifier Type: -

Identifier Source: org_study_id