Nick Daneman1,2,3,4,5, Samantha M Lee3, Heming Bai6, Chaim M Bell3,4,5,7, Susan E Bronskill1,3,4,5,8, Michael A Campitelli3, Gail Dobell6, Longdi Fu3, Gary Garber2,9, Noah Ivers3,5,8, Jonathan M C Lam6, Bradley J Langford2, Celia Laur8, Andrew Morris5,7, Cara Mulhall6, Ruxandra Pinto1, Farah E Saxena3, Kevin L Schwartz2,3, Kevin A Brown2,3. 1. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 2. Public Health Ontario, Toronto, Ontario, Canada. 3. Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada. 4. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 5. Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 6. Ontario Health, Toronto, Ontario, Canada. 7. Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada. 8. Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada. 9. Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Abstract
BACKGROUND: Antibiotic overprescribing in long-term care settings is driven by prescriber preferences and is associated with preventable harms for residents. We aimed to determine whether peer comparison audit and feedback reporting for physicians reduces antibiotic overprescribing among residents. METHODS: We employed a province wide, difference-in-differences study of antibiotic prescribing audit and feedback, with an embedded pragmatic randomized controlled trial (RCT) across all long-term care facilities in Ontario, Canada, in 2019. The study year included 1238 physicians caring for 96 185 residents. In total, 895 (72%) physicians received no feedback; 343 (28%) were enrolled to receive audit and feedback and randomized 1:1 to static or dynamic reports. The primary outcomes were proportion of residents initiated on an antibiotic and proportion of antibiotics prolonged beyond 7 days per quarter. RESULTS: Among all residents, between the first quarter of 2018 and last quarter of 2019, there were temporal declines in antibiotic initiation (28.4% to 21.3%) and prolonged duration (34.4% to 29.0%). Difference-in-differences analysis confirmed that feedback was associated with a greater decline in prolonged antibiotics (adjusted difference -2.65%, 95% confidence interval [CI]: -4.93 to -.28%, P = .026), but there was no significant difference in antibiotic initiation. The reduction in antibiotic durations was associated with 335 912 fewer days of treatment. The embedded RCT detected no differences in outcomes between the dynamic and static reports. CONCLUSIONS: Peer comparison audit and feedback is a pragmatic intervention that can generate small relative reductions in the use of antibiotics for prolonged durations that translate to large reductions in antibiotic days of treatment across populations. Clinical Trials Registration. NCT03807466.
BACKGROUND: Antibiotic overprescribing in long-term care settings is driven by prescriber preferences and is associated with preventable harms for residents. We aimed to determine whether peer comparison audit and feedback reporting for physicians reduces antibiotic overprescribing among residents. METHODS: We employed a province wide, difference-in-differences study of antibiotic prescribing audit and feedback, with an embedded pragmatic randomized controlled trial (RCT) across all long-term care facilities in Ontario, Canada, in 2019. The study year included 1238 physicians caring for 96 185 residents. In total, 895 (72%) physicians received no feedback; 343 (28%) were enrolled to receive audit and feedback and randomized 1:1 to static or dynamic reports. The primary outcomes were proportion of residents initiated on an antibiotic and proportion of antibiotics prolonged beyond 7 days per quarter. RESULTS: Among all residents, between the first quarter of 2018 and last quarter of 2019, there were temporal declines in antibiotic initiation (28.4% to 21.3%) and prolonged duration (34.4% to 29.0%). Difference-in-differences analysis confirmed that feedback was associated with a greater decline in prolonged antibiotics (adjusted difference -2.65%, 95% confidence interval [CI]: -4.93 to -.28%, P = .026), but there was no significant difference in antibiotic initiation. The reduction in antibiotic durations was associated with 335 912 fewer days of treatment. The embedded RCT detected no differences in outcomes between the dynamic and static reports. CONCLUSIONS: Peer comparison audit and feedback is a pragmatic intervention that can generate small relative reductions in the use of antibiotics for prolonged durations that translate to large reductions in antibiotic days of treatment across populations. Clinical Trials Registration. NCT03807466.
Authors: Nick Daneman; Andrea Gruneir; Alice Newman; Hadas D Fischer; Susan E Bronskill; Paula A Rochon; Geoff M Anderson; Chaim M Bell Journal: J Antimicrob Chemother Date: 2011-09-27 Impact factor: 5.790
Authors: Bradley J Langford; Jacquelyn Quirk; Stacie Carey; Nick Daneman; Gary E Garber Journal: Am J Infect Control Date: 2019-07-18 Impact factor: 2.918
Authors: Kevin Antoine Brown; Andrea Chambers; Sam MacFarlane; Bradley Langford; Valerie Leung; Jacquelyn Quirk; Kevin L Schwartz; Gary Garber Journal: CMAJ Open Date: 2019-03-29
Authors: Cara L Mulhall; Jonathan M C Lam; Patrick S Rich; L Gail Dobell; Anna Greenberg Journal: J Am Med Dir Assoc Date: 2020-01-20 Impact factor: 4.669
Authors: Nick Daneman; Susan E Bronskill; Andrea Gruneir; Alice M Newman; Hadas D Fischer; Paula A Rochon; Geoffrey M Anderson; Chaim M Bell Journal: JAMA Intern Med Date: 2015-08 Impact factor: 21.873
Authors: Nick Daneman; Andrea Gruneir; Susan E Bronskill; Alice Newman; Hadas D Fischer; Paula A Rochon; Geoff M Anderson; Chaim M Bell Journal: JAMA Intern Med Date: 2013-04-22 Impact factor: 21.873
Authors: Noah M Ivers; Jeremy M Grimshaw; Gro Jamtvedt; Signe Flottorp; Mary Ann O'Brien; Simon D French; Jane Young; Jan Odgaard-Jensen Journal: J Gen Intern Med Date: 2014-11 Impact factor: 5.128
Authors: Nick Daneman; Samantha Lee; Heming Bai; Chaim M Bell; Susan E Bronskill; Michael A Campitelli; Gail Dobell; Longdi Fu; Gary Garber; Noah Ivers; Matthew Kumar; Jonathan M C Lam; Bradley Langford; Celia Laur; Andrew M Morris; Cara L Mulhall; Ruxandra Pinto; Farah E Saxena; Kevin L Schwartz; Kevin A Brown Journal: Open Forum Infect Dis Date: 2022-03-02 Impact factor: 3.835
Authors: Manon R Haverkate; Derek R Macfadden; Nick Daneman; Jenine Leal; Michael Otterstatter; Roshanak Mahdavi; Adam G D'Souza; Elissa Rennert-May; Michael Silverman; Kevin L Schwartz; Andrew M Morris; Ariana Saatchi; David M Patrick; Fawziah Marra Journal: Antibiotics (Basel) Date: 2022-07-26