Feasibility of a Low-Intensity Intervention to Influence Antibiotic Prescribing Rates Use in Outpatient Settings: A Cluster Randomized Controlled Clinical Trial

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Abstract Background Primary care providers (PCPs) may modify their antibiotic prescription practices if aware of their potentially damaging impact. Methods We conducted a cluster randomized controlled trial at 12 Veterans Affairs community-based outpatient clinics. PCPs at clinics randomized to the intervention group received quarterly Antibiotic Use Reports with feedback about antibiotics prescribed for acute respiratory infections and Adverse Event Letters alerting about Clostridioides difficile infection or antibiotic-resistant Gram-negative bacteria among their patients. The main outcome, antibiotic prescriptions in primary care visits, was compared in the pre-intervention (4/2020– 9/2020), intervention (10/2020–9/2021), and post-intervention periods (9/2021–9/2022). Results Among 52 PCPs at 6 clinics in the intervention group, 66% (33/52) and 54% (28/52) received ≥1 Antibiotic Use Report and Adverse Event Letter. In the intervention clinics, the proportion of primary care visits with antibiotic prescription during the pre-intervention, intervention, and post-intervention periods was 1.4% (1088/77697), 1.4% (2051/147858), and 1.3% (1692/131530). In the control clinics, this increased from 1.8% (1560/87897) to 2.1% (3707/176825) and 2.1% (3418/162979) during the intervention and post-intervention periods. The rate of visits with antibiotic prescription did not differ in the pre-intervention period (odds ratio (OR) and 95% confidence interval (CI) = 1.10 (0.87, 1.39), P=0.431) but did during the intervention (OR (95% CI) = 1.30 (1.04, 1.62), P=0.022) and post-intervention periods (OR (95% CI) = 1.38 (1.09, 1.74), P=0.007). There were no differences in emergency visits and hospitalizations. Conclusions PCPs from clinics assigned to a low-intensity intervention combining comparative feedback with adverse event notifications had lower antibiotic prescription rates.