Abstract
To assess the effect of individual compared to clinic-level feedback on guideline-concordant care for 3 acute respiratory tract infections (ARTIs) among family medicine clinicians caring for pediatric patients. Cluster randomized controlled trial with a 22-month baseline, 26-month intervention period, and 12-month postintervention period. In total, 26 family medicine practices (39 clinics) caring for pediatric patients in Virginia, North Carolina, and South Carolina were selected based upon performance on guideline-concordance for 3 ARTIs, stratified by practice size. These were randomly allocated to a control group (17 clinics in 13 practices) or to an intervention group (22 clinics in 13 practices). All clinicians received an education session and baseline then monthly clinic-level rates for guideline-concordant antibiotic prescribing for ARTIs: upper respiratory tract infection (URI), acute bacterial sinusitis (ABS), and acute otitis media (AOM). For the intervention group only, individual clinician performance was provided. Both intervention and control groups demonstrated improvement from baseline, but the intervention group had significantly greater improvement compared with the control group: URI (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.37-1.92; P < 0.01); ABS (OR, 1.45; 95% CI, 1.11-1.88; P < 0.01); and AOM (OR, 1.59; 95% CI, 1.24-2.03; P < 0.01). The intervention group also showed significantly greater reduction in broad-spectrum antibiotic prescribing percentage (BSAP%): odds ratio 0.80, 95% CI 0.74-0.87, P < 0.01. During the postintervention year, gains were maintained in the intervention group for each ARTI and for URI and AOM in the control group. Monthly individual peer feedback is superior to clinic-level only feedback in family medicine clinics for 3 pediatric ARTIs and for BSAP% reduction. ClinicalTrials.gov identifier: NCT04588376, Improving Antibiotic Prescribing for Pediatric Respiratory Infection by Family Physicians with Peer Comparison.
Highlights
Ambulatory settings account for ∼60% of antibiotic expenditures,[1] and it has been estimated that ∼30% of antibiotic use in these settings is unnecessary.[2]
The control group improved for upper respiratory tract infection (URI) by 17.0%, acute bacterial sinusitis (ABS) improved by16.5%, and acute otitis media (AOM) improved by 18.5%, with mean improvement overall of 17.3% (Table 2)
Intracluster correlations, estimated from the generalized linear mixed model (GLMM), for URI, ABS, AOM, and BSAP% were 0.172, 0.117, 0.138, and 0.063, respectively, indicating that 17%, 12%, 14%, and 6%, respectively, of the variability in the outcomes can be explained by between-clinic differences. In this cluster randomized trial among family medicine clinics, individual clinician feedback resulted in superior performance compared to clinic-level feedback for pediatric acute respiratory tract infections (ARTIs)
Summary
Ambulatory settings account for ∼60% of antibiotic expenditures,[1] and it has been estimated that ∼30% of antibiotic use in these settings is unnecessary.[2] In ambulatory settings, audit and feedback has been shown to decrease inappropriate antibiotic prescribing and was recently recommended among the core elements of ambulatory stewardship.[3,4,5,6,7,8,9,10,11,12] Behavioral science research shows individual data provision for quality improvement may be more effective tha
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: Antimicrobial stewardship & healthcare epidemiology : ASHE
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
