British Columbia Prescriber Feedback Program - Antimicrobial Resistance
Trial statusNot yet recruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18+
SponsorUniversity of British Columbia
About this trial
The goal of this study is to evaluate an educational intervention that aims to reduce the number of unnecessary antibiotics prescribed by family physicians and nurse practitioners in British Columbia, Canada.
The intervention materials include a confidential personalized prescribing "portrait" and an evidence-based educational summary (therapeutics letter), accompanied by an introduction letter.
The main research questions are:
1. Will the intervention lead to a reduction in the overall number of antibiotics prescriptions started? 2. Will the intervention lead to a reduction in the proportion of antibiotics prescribed that are likely unnecessary, especially prescriptions for upper respiratory tract infections, acute bronchitis, acute sinusitis?
Researchers will conduct an intervention study with family physicians and nurse practitioners in British Columbia, Canada. Participant clinicians will be randomly assigned to one of two groups. The Early Group will consist of 80% of the participants and will receive the intervention (prescribing portrait, evidence summary, and introduction letter) at the start of the study. The Delayed Group will consist of 20% of participants and will receive the intervention about nine months later. This study design allows most practitioners to receive the intervention early while still allowing time to compare the two groups to assess the impact. To estimate the impact of the intervention, researchers will use administrative health data to compare the prescribing of the Early Group with prescribing of the Delayed Group.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
A valid MSP billing number;
Status of Salaried, Private Practice, Temporary Licence, or Post Graduate;
Prescribed >100 dispensed medications in 2024.
Disqualifiers
Previously opted out of the Therapeutics Initiative Portrait program
Age <18 years at time of oral antibiotic dispensation;
Received PharmaCare benefits through the Palliative Care program at any time during the baseline or study period;
Hospitalized within 1 week prior to an antibiotic prescription at any time during the baseline or study period;
Trial design
Design model
Sequential
Treatments tested in this trial
Prescribing portrait audit and feedback
BehavioralThe prescribing portrait audit-and-feedback intervention consists of a confidential, personalized prescribing audit-and-feedback report (Portrait), an evidence-based educational summary (therapeutics letter), and an introduction letter. The prescribing portrait uses linked BC Ministry of Health administrative claims data and presents two key recommendations: (1) reduce the proportion of patient visits resulting in an antibiotic prescription, and (2) avoid routinely prescribing antibiotics for upper respiratory tract infections, acute bronchitis, and acute sinusitis. Each recommendation is accompanied by a bar graph showing the prescriber's 2024 performance compared with the median prescriber in British Columbia and an achievable target. The intervention will be delivered using a secure paper mailing process. During every aspect of production and delivery, prescribing data are confidential and protected.
Treatment groups
7,626 Participants
are divided into 2 treatment groupsGroup A: Early Group - Prescribing portrait audit and feedbackExperimental treatment 1 intervention
Group B: Delayed control - Prescribing portrait audit-and-feedbackExperimental treatment 1 intervention
Trial outcomes
Primary outcomes
1
Weekly rate of incident oral antibiotic prescribing
The primary outcome is the number of incident oral antibiotic prescriptions per practitioner per week. Follow-up time will be calculated for each practitioner in the 52 weeks before and 39 weeks after the portrait is mailed to the Early group. A practitioner will count as contributing a full week (7 days) of follow-up if, during that week, they either: 1) wrote at least one prescription (recorded in PharmaNet), or 2) billed the Medical Services Plan for at least one patient visit. Weekly prescribing rates will be plotted by Early and Delayed groups and analyzed using Poisson regression with generalized estimating equations to account for repeated measures. Models will adjust for cohort (Early vs. Delay), age, sex, rural practice, and provider type. The intervention effect will be estimated using a pre-post level-change variable and its interaction with cohort status, representing the adjusted mean impact of the portrait.
Time frame
From trial initiation to 30 days, 3, 6, and 9 months post-interventionSecondary outcomes
1
Weekly rate of 'likely unnecessary' antibiotic prescriptions
Weekly rate of 'likely unnecessary' incident oral antibiotic prescribing per practitioner. An antibiotic prescription is defined as 'likely unnecessary' if the dispensing occurs within 5 days of a physician visit with a diagnosis where oral antibiotic treatment is 'never appropriate'. The 'achievable target' comparator is defined as the top 25% of physicians with the lowest proportion of likely unnecessary prescriptions. is defined as the top 25% of physicians with the lowest proportion of likely unnecessary prescriptions. Analyses will be conducted and reported using the same methodology as the primary analyses.
Time frame
From trial initiation to 30 days, 3, 6, and 9 months post-intervention2
Weekly rate of 'likely unnecessary' condition-specific antibiotic prescriptions
Weekly rate of 'likely unnecessary' condition-specific incident oral antibiotic prescribing per practitioner for the following conditions: 1) upper respiratory tract infections (URTI), 2) acute bronchitis, 3) acute sinusitis. An antibiotic prescription is defined as 'likely unnecessary' if the dispensing occurs within 5 days of a physician visit with a diagnosis where oral antibiotic treatment is 'never appropriate'. The 'achievable target' comparator is defined as the top 25% of physicians with the lowest proportion of likely unnecessary prescriptions. Analyses will be conducted and reported using the same methodology as the primary analyses.
Time frame
From trial initiation to 30 days, 3, 6, and 9 months post-interventionSponsors and contacts
Click on the lead sponsor to view all of their trials.
University of British Columbia
Lead sponsor
Ministry of Health, British Columbia
Collaborator
British Columbia Centre for Disease Control
Collaborator
Source ClinicalTrials.gov
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