פוסט זה זמין גם ב:
עברית
A Randomized Clinical Trial
Soheila Aghlmandi, PhD1; Florian S. Halbeisen, PhD1; Ramon Saccilotto, MD2; et alPascal Godet3; Andri Signorell4; Simon Sigrist5; Dominik Glinz, PhD1; Giusi Moffa, PhD6; Andreas Zeller, MD7; Andreas F. Widmer, MD, MSc8; Andreas Kronenberg, MD9; Julia Bielicki, MD, PhD10,11; Heiner C. Bucher, MD, MPH1
Author Affiliations Article Information
JAMA Intern Med. 2023;183(3):213-220. doi:10.1001/jamainternmed.2022.6529
Key Points
Question Does automated quarterly antibiotic prescribing feedback with peer benchmarking over 2 years reduce antibiotic prescribing in the second year of the intervention among primary care physicians who are the top 75% prescribers of antibiotics (ie, with medium to high antibiotic prescription rates)?
Findings In this randomized clinical trial of 3426 primary care physicians in Switzerland, there was a 4% relative increase in antibiotic prescribing during the second year of the intervention (2019) compared with the baseline year (2017). The median annual antibiotic prescribing rate per 100 consultations was 8.2 in the feedback and audit group and 8.4 in the control group in the second year of the intervention.
Meaning Among primary care physicians with medium to high antibiotic prescription rates, antibiotic prescribing audit and feedback did not reduce antibiotic prescribing.
Abstract
Importance Antibiotics are commonly prescribed in primary care, increasing the risk of antimicrobial resistance in the population.
Objective To investigate the effect of quarterly audit and feedback on antibiotic prescribing among primary care physicians in Switzerland with medium to high antibiotic prescription rates.
Design, Setting, and Participants This pragmatic randomized clinical trial was conducted from January 1, 2018, to December 31, 2019, among 3426 registered primary care physicians and pediatricians in single or small practices in Switzerland who were among the top 75% prescribers of antibiotics. Intention-to-treat analysis was performed using analysis of covariance models and conducted from September 1, 2021, to January 31, 2022.
Interventions Primary care physicians were randomized in a 1:1 fashion to undergo quarterly antibiotic prescribing audit and feedback with peer benchmarking vs no intervention for 2 years, with 2017 used as the baseline year. Anonymized patient-level claims data from 3 health insurers serving roughly 50% of insurees in Switzerland were used for audit and feedback. The intervention group also received evidence-based guidelines for respiratory tract and urinary tract infection management and community antibiotic resistance information. Physicians in the intervention group were blinded regarding the nature of the trial, and physicians in the control group were not informed of the trial.
Main Outcomes and Measures The claims data used for audit and feedback were analyzed to assess outcomes. Primary outcome was the antibiotic prescribing rate per 100 consultations during the second year of the intervention. Secondary end points included overall antibiotic use in the first year and over 2 years, use of quinolones and oral cephalosporins, all-cause hospitalizations, and antibiotic use in 3 age groups.
Results A total of 3426 physicians were randomized to the intervention (n = 1713) and control groups (n = 1713) serving 629 825 and 622 344 patients, respectively, with a total of 4 790 525 consultations in the baseline year of 2017. In the entire cohort, a 4.2% (95% CI, 3.9%-4.6%) relative increase in the antibiotic prescribing rate was noted during the second year of the intervention compared with 2017. In the intervention group, the median annual antibiotic prescribing rate per 100 consultations was 8.2 (IQR, 6.1-11.4) in the second year of the intervention and was 8.4 (IQR, 6.0-11.8) in the control group. Relative to the overall increase, a –0.1% (95% CI, –1.2% to 1.0%) lower antibiotic prescribing rate per 100 consultations was found in the intervention group compared with the control group. No relevant reductions in specific antibiotic prescribing rates were noted between groups except for quinolones in the second year of the intervention (–0.9% [95% CI, –1.5% to –0.4%]).
Conclusions and Relevance This randomized clinical trial found that quarterly personalized antibiotic prescribing audit and feedback with peer benchmarking did not reduce antibiotic prescribing among primary care physicians in Switzerland with medium to high antibiotic prescription rates.
