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

Greg Carney; Malcolm Maclure; David M Patrick; Anat Fisher; Dana Stanley; Ken Bassett; Colin R Dormuth

doi:10.1371/journal.pone.0280096

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

PLoS One. 2023 Jul 31;18(7):e0280096. doi: 10.1371/journal.pone.0280096. eCollection 2023.

Authors

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

¹ Therapeutics Initiative, University of British Columbia, Vancouver, BC, Canada.
² Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada.
³ British Columbia Centre for Disease Control, Vancouver, BC, Canada.
⁴ School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
⁵ Department of Family Practice, University of British Columbia, Vancouver, BC, Canada.

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.

Copyright: © 2023 Carney et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Acute Disease
Anti-Bacterial Agents / therapeutic use
Cystitis* / drug therapy
Escherichia coli
Feedback
Female
Humans
Inappropriate Prescribing
Physicians, Family*
Practice Patterns, Physicians'

Substances

Anti-Bacterial Agents

Associated data

ISRCTN/ISRCTN16938907

Grants and funding

The study was funded through a contribution agreement to the University of British Columbia from the British Columbia Ministry of Health. The funder played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.