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Routine Prescription Feedback and Peer Comparison to Lower Antibiotic Prescriptions in Primary Care - a Pragmatic Randomized Controlled Trial

English title Routine Prescription Feedback and Peer Comparison to Lower Antibiotic Prescriptions in Primary Care - a Pragmatic Randomized Controlled Trial
Applicant Bucher Heiner C.
Number 140997
Funding scheme Project funding (Div. I-III)
Research institution Institut für klinische Epidemiologie Universitätsspital Basel
Institution of higher education University of Basel - BS
Main discipline Infectious Diseases
Start/End 01.06.2012 - 31.12.2015
Approved amount 224'642.00
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All Disciplines (2)

Discipline
Infectious Diseases
Methods of Epidemiology and Preventive Medicine

Keywords (7)

antibiotic resistance; peer comparison; pragmatic population trial; antibiotics; quality of care ; webapplication; primary care

Lay Summary (English)

Lead
Lay summary

Excessive use of antibiotics may lead to unnecessary adverse events and raise the emergence of bacterial resistance, an increasingly serious problem in Europe. Most antibiotics are prescribed in primary care with considerable unexplained variation of antibiotic use, indicating the need for further improvement of prescription practice in Switzerland.

The aim of this randomized controlled trial is therefore to evaluate the long-term effect of a continuous postal and web-based feedback and peer comparison system of individual antibiotic prescription rates on the prescription behaviour of primary care physicians in Switzerland.

For 24 months, primary care physicians with a high rate of antibiotic prescriptions that are allocated to the intervention group will receive quarterly postal and electronic feedback on the crude number of antibiotics prescribed, a patient population adjusted benchmark-profile in comparison to other primary care physicians, and evidence based guidelines on the use of antibiotics in primary care. Physicians in the control group will be monitored but will not be contacted. Individual antibiotic prescription rates will be deduced from invoice data that is regularly collected by social health insurance companies and that is provided through the “Santésuisse Datenpool” and “Tarifpool”.

In addition to the feedback on prescription rates, the feasibility of a web-based interface as communication tool to primary care physicians will be assessed and quality indicators for antibiotic prescription as proposed by the “European Surveillance of Antimicrobial Consumption“ project will be validated in a subgroup of physicians.

If effective, the system could be easily employed for other interventions as well.

Direct link to Lay Summary Last update: 21.02.2013

Responsible applicant and co-applicants

Employees

Publications

Collaboration

Group / person Country
Types of collaboration
Klinik für Infektiologie und Spitalhygiene, Universitätsspital Basel Switzerland (Europe)
- Publication
- Research Infrastructure
santésuisse SASIS Switzerland (Europe)
- Publication
- Research Infrastructure
- Industry/business/other use-inspired collaboration
General Practice Respiratory Tract Infections Network Netherlands (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Institut für Hausarztmedizin, Universitätsspital Basel Switzerland (Europe)
- Publication
- Research Infrastructure
University of Southampton Great Britain and Northern Ireland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Exchange of personnel
European Surveillance of Antimicrobial Consumption (ESAC) Belgium (Europe)
- in-depth/constructive exchanges on approaches, methods or results

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
European Congress of Clinical Microbiology and Infectious Diseases Individual talk Personalized prescription feedback to reduce antibiotic overuse in primary care: a nationwide pragmatic randomized trial using routinely collected health data 10.04.2016 Amsterdam, Netherlands Raatz Heike; Widmer Andreas; Zumbrunn Thomas; Saccilotto Ramon; Hemkens Lars; Bucher Heiner C.;
Schweizerische Akademie der Medizinischen Wissenschaften Versorgungsforschung in der Schweiz: Poster BENCHMARKING TO LOWER ANTIBIOTIC PRESCRIPTIONS IN PRIMARY CARE: OUTLINE OF A PRAGMATIC RCT 01.11.2012 Bern, Switzerland Zumbrunn Thomas; Bucher Heiner C.; Saccilotto Ramon; Raatz Heike; Widmer Andreas;
General Practice Research on Infections Network Meeting GRIN Individual talk Routine peer benchmarking to lower antibiotic prescription in primary care – a nationwide pragmatic randomised controlled trial 07.09.2012 Bristol, Great Britain and Northern Ireland Bucher Heiner C.; Achermann Rita; Hemkens Lars; Saccilotto Ramon; Zumbrunn Thomas; Widmer Andreas; Raatz Heike;
G-I-N Conference Deutschsprachiges Satellitensymposium „Leitlinien und Qualitätsförderung“ Individual talk EbM und Leitlinien in der Schweiz. 22.08.2012 Berlin, Germany Widmer Andreas; Hemkens Lars; Saccilotto Ramon; Zumbrunn Thomas; Bucher Heiner C.; Raatz Heike;


Communication with the public

Communication Title Media Place Year
Media relations: print media, online media Beratungsresistente Ärzte NZZ 2. 1. 2017 German-speaking Switzerland 2017
Media relations: radio, television Zu hoher Antibiotikaeinsatz in der Schweiz SRF DRS Puls German-speaking Switzerland 2017
Media relations: print media, online media Pilotprojekt zur Verbesserung der Qualität der Antibiotikaverschreibung in der ambulanten Versorgung Primary Care 2013;13: Nr. 16 German-speaking Switzerland 2013

Associated projects

Number Title Start Funding scheme
102137 Multidimensional intervention programme to reduce antibiotic prescriptions for acute respiratory tract infections in adults: A randomised controlled trial in primary care 01.10.2003 Project funding (Div. I-III)
107772 Procalcitonin guided antibiotic use in acute respiratory tract infection in primary care - a randomized controlled trial 01.04.2005 Project funding (Div. I-III)
111770 Antibiotics for clinically diagnosed acute rhinosinusitis: an individual patient data meta-analysis (IPDMA) of randomised controlled trials (RCTs) 01.04.2006 Project funding (Div. I-III)
167066 Routine antibiotic prescription and resistance monitoring in primary care physicians: A nationwide pragmatic randomized controlled trial 01.01.2017 NRP 72 Antimicrobial Resistance
116177 Procalcitonin guided antibiotic therapy and hospitalisation in patients with lower respiratory tract infections. The "ProHOSP" Study 01.04.2007 Project funding (Div. I-III)
122455 Procalcitonin or C reactive protein versus guidelines for patient management of acute respiratory tract infections in primary care: A randomized controlled pragmatic trial 01.08.2010 Project funding (Div. I-III)

Abstract

Background: Excessive use of antibiotics may lead to unnecessary adverse events and raise the emergence of bacterial resistance, an increasingly serious problem in Europe. In absolute terms most antibiotics are prescribed in primary care with considerable unexplained variation of antibiotic use indicating the need for further important improvement of prescription practice in Switzerland.Aim: To evaluate the effect of a continuous postal and web-based feedback and peer comparison system of individual antibiotic prescription rates on the prescription behaviour of primary care physicians in Switzerland.Design: Randomized, controlled, pragmatic intervention trial.Setting: Primary care providers of Switzerland above the median of antibiotic prescription rates.Population: Primary care physicians caring for patients enlisted with social health insurance companies that provide invoice data to the santesuisse Datenpool AND Tarifpool.Endpoints: Primary endpoint: Prescription rate of antibiotics as defined daily doses (DDD) per 100 consultations at 12 and 24 months. Secondary endpoints: Costs-savings from the intervention, acceptability of the program, percentage of prescriptions fulfilling disease-specific quality indicators for outpatient antibiotic criteria by the European Surveillance of Antimicrobial Consumption (ESAC).Intervention: Quarterly postal and electronic feedback for 24 months on the crude number of antibiotics prescribed, a population adjusted benchmark-profile in comparison to other primary care physicians, and evidence-based guidelines for the use of antibiotics in primary care. Physicians in the control group receive no information.Variables and measurement: Rates of antibiotic prescriptions overall and per drug class (DDD), cost of prescribed drugs and the intervention program; number of web-application logins and participation cancellations, and - in a sub-sample - number of prescriptions fulfilling disease-specific quality indicators for outpatient antibiotic criteria (ESAC).Expected results: We expect a 5% reduction of antibiotic prescription rates between the intervention and control groups after 12 months with an assumed participation rate (at least one web-access) and return of acceptance questionnaire of 30%. We expect that the intervention program will be cost-saving. ESAC quality indicators will be a useful tool for monitoring the quality of antibiotic prescription in ambulatory care in Switzerland.Analyses: Analysis will be done by intention to treat principles. We will use linear regression analysis to determine the difference in antibiotic prescriptions between the intervention and the control group with appropriate adjustment for the case mix of patient populations and self-dispensation. Based on outpatient data of 2009 from the Helsana insurance and conservative effect estimates a sample-size of 1427 physicians each for the intervention and control group is planned.Significance: This trial will investigate if a repeated feedback system results in a long-term reduction of antibiotic prescription practices. In addition, the feasibility of a web-based interface as communication tool to primary care physicians will be assessed. If effective, the system could be easily employed for other interventions as well.
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