Providing physicians with feedback reduces antibiotic overprescribing

A study published in JAMA this week found that providing physicians with feedback about their antibiotic prescribing can enhance both patient outcomes and health system sustainability. Led by Public Health Ontario scientist Dr. Kevin Schwartz and Women’s College Hospital clinician-scientist Dr. Noah Ivers, the trial looked at how providing physicians with feedback about their antibiotic prescribing can enhance both patient outcomes and health system sustainability. It was the first antibiotic audit and feedback trial in Canada and the first to show the benefits of providing prescribing feedback on antibiotic duration. Noting that antibiotic overuse contributes to adverse drug effects, increased costs, and antimicrobial resistance, the researchers asked whether providing a single, mailed, peer-comparison letter on antibiotic use to high-prescribing primary care physicians (PCPs) could modify their prescribing behaviour. In this randomized clinical trial of 3,500 high-prescribing PCPs in Ontario, receipt of a letter targeting appropriate antibiotic durations resulted in a statistically significant 4.8% relative reduction in total antibiotic use, 8.1% relative reduction in prolonged durations and 6.1% relative reduction in antibiotic drug costs. “Our aim was to evaluate the impact of notifying PCPs that they are in the highest antibiotic prescribing quartile compared to their peers,” Dr. Ivers told the Women’s College Hospital newsletter. “We hypothesized that social normative feedback would impact antibiotic initiation. We further estimated that focused educational content on appropriate initiation, or duration, would have additional effects on the volume of antibiotics prescribed or volume of prolonged duration prescriptions,” he added. The authors concluded that a single, peer-comparison, antibiotic-feedback letter to high-prescribing physicians can be effective and cost-saving, especially if it includes targeted messaging on appropriate durations of antibiotic prescriptions. The team will be taking the research further with a second letter trial planned for fall 2021 that will use ICES data. This new data set will enable the research team to link prescriber characteristics (including volume), as well as patient characteristics (including comorbidities), to prescription data.

Providing physicians with feedback reduces antibiotic overprescribing

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