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Randomized Controlled Trial
. 2023 Jul 31;18(7):e0280096.
doi: 10.1371/journal.pone.0280096. eCollection 2023.

A cluster randomized trial assessing the impact of personalized prescribing feedback on antibiotic prescribing for uncomplicated acute cystitis to family physicians

Greg Carney  1   2 , Malcolm Maclure  1   2 , David M Patrick  3   4 , Anat Fisher  1   2 , Dana Stanley  1   2 , Ken Bassett  1   2   5 , Colin R Dormuth  1   2
Affiliations
Randomized Controlled Trial

A cluster randomized trial assessing the impact of personalized prescribing feedback on antibiotic prescribing for uncomplicated acute cystitis to family physicians

Greg Carney et al. PLoS One. .

Abstract

Objective: To evaluate the impact of personalized prescribing portraits on antibiotic prescribing for treating uncomplicated acute cystitis (UAC) by Family Physicians (FPs).

Design: Cluster randomized control trial.

Setting: The intervention was conducted in the primary care setting in the province of BC between December 2010 and February 2012.

Participants: We randomized 4 833 FPs by geographic location into an Early intervention arm (n = 2 417) and a Delayed control arm (n = 2 416).

Intervention: The Education for Quality Improvement in Patient Care (EQIP) program mailed to each FP in BC, a 'portrait' of their individual prescribing of antibiotics to women with UAC, plus therapeutic recommendations and a chart of trends in antibiotic resistance.

Main outcome measures: Antibiotic prescribing preference to treat UAC.

Results: Implementing exclusion criteria before and after a data system change in the Ministry of Health caused the arms to be unequal in size-intervention arm (1 026 FPs, 17 637 UAC cases); control arm (1 352 FPs, 25 566 UAC cases)-but they were well balanced by age, sex and prior rates of prescribing antibiotics for UAC. In the early intervention group probability of prescribing nitrofurantoin increased from 28% in 2010 to 38% in 2011, a difference of 9.9% (95% confidence interval [CI], 9.1% to 10.7. Ciprofloxacin decreased by 6.2% (95% CI: 5.6% to 6.9%) and TMP-SMX by 3.7% (95% CI: 3.1% to 4.2%). Among 295 FPs who completed reflective surveys, 52% said they were surprized by the E. coli resistance statistics and 57% said they planned to change their treatment of UAC.

Conclusion: The EQIP intervention demonstrated that feedback of personal data to FPs on their prescribing, plus population data on antibiotic resistance, with a simple therapeutic recommendation, can significantly improve prescribing of antibiotics. Trial registration: ISRCTN 16938907.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study physician flow diagram.
Fig 2
Fig 2. Trends in preferences.
a: Monthly antibiotic preference trends assuming zero clustering, b: Monthly antibiotic preference trends assuming 100% clustering.
See this image and copyright information in PMC

References

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