Evidence map›Paper›PMID 34525972›Full record

Trial reportBMC family practice2021

A pragmatic randomized trial of a primary care antimicrobial stewardship intervention in Ontario, Canada.

Warren McIsaac, Sahana Kukan, Ella Huszti, Leah Szadkowski, Braden O'Neill, Sophia Virani, Noah Ivers, Rosemarie Lall, Navsheer Toor, Mruna Shah and 4 more

Registry-linked trialAbstract readPragmatic Clinical TrialRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC family practice, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03517215 (The Development and Testing of a Scaling Strategy for a Community-based Primary Care Antimicrobial Stewardship Program Utilizing an Innovative University of Toronto Primary Care Testing Platform), which is not on this map. Cited by 16 papers.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03517215 naunknown statusnot on this map

The Development and Testing of a Scaling Strategy for a Community-based Primary Care Antimicrobial Stewardship Program Utilizing an Innovative University of Toronto Primary Care Testing Platform: the UTOPIAN Practice Based Research Network

TypeinterventionalSponsorUniversity of TorontoRan2018 to 2020Enrolled60ConditionsAcute Rhinosinusitis, Sore Throat, Acute Cystitis, Acute BronchitisArmsEnhanced CB-ASP, Standard CB-ASP
3 · Its place in the literature

Who cites it

16 citing papers in PubMed.

  1. Trial
  2. Penicillin allergies and community antibiotic prescriptions: A secondary analysis of prescribing choices in six family medicine clinics in southern Ontario, 2018-2019.Journal of the Association of Medical Microbiology and Infectious Disease Canada = Journal officiel de l'Association pour la microbiologie medicale et l'infectiologie Canada · 2026
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  4. Review
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  7. Review
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  12. Review
  13. Short-course antibiotic therapy: The next frontier in antimicrobial stewardship.Canada communicable disease report = Releve des maladies transmissibles au Canada · 2022
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  14. Review
  15. Article
  16. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Warren McIsaacDepartment of Family and Community Medicine, University of Toronto, Toronto, Canada. warren.mcisaac@sinaihealth.ca.
Sahana KukanRay D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health, 60 Murray St, Toronto, ON, M5T 3L9, Canada.
Ella HusztiBiostatistics Research Unit, University Health Network, Toronto, Canada.
Leah SzadkowskiBiostatistics Research Unit, University Health Network, Toronto, Canada.
Braden O'NeillDepartment of Family and Community Medicine, University of Toronto, Toronto, Canada.
Sophia ViraniRay D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health, 60 Murray St, Toronto, ON, M5T 3L9, Canada.
Noah IversDepartment of Family and Community Medicine, University of Toronto, Toronto, Canada.
Rosemarie LallDepartment of Family and Community Medicine, University of Toronto, Toronto, Canada.
Navsheer ToorDepartment of Family and Community Medicine, University of Toronto, Toronto, Canada.
Mruna ShahDepartment of Family and Community Medicine, University of Toronto, Toronto, Canada.
Ruby AlviDepartment of Family and Community Medicine, University of Toronto, Toronto, Canada.
Aashka BhattDepartment of Family and Community Medicine, University of Toronto, Toronto, Canada.
Yoshiko NakamachiAntimicrobial Stewardship Program, University Health Network, Toronto, Canada.
Andrew M MorrisAntimicrobial Stewardship Program, University Health Network, Toronto, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMore than 90% of antibiotics are prescribed in primary care, but 50% may be unnecessary. Reducing unnecessary antibiotic overuse is needed to limit antimicrobial resistance. We conducted a pragmatic trial of a primary care provider-focused antimicrobial stewardship intervention to reduce antibiotic prescriptions in primary care.

methodsPrimary care practitioners from six primary care clinics in Toronto, Ontario were assigned to intervention or control groups to evaluate the effectiveness of a multi-faceted intervention for reducing antibiotic prescriptions to adults with respiratory and urinary tract infections. The intervention included provider education, clinical decision aids, and audit and feedback of antibiotic prescribing. The primary outcome was total antibiotic prescriptions for these infections. Secondary outcomes were delayed prescriptions, prescriptions longer than 7 days, recommended antibiotic use, and outcomes for individual infections. Generalized estimating equations were used to estimate treatment effects, adjusting for clustering by clinic and baseline differences.

resultsThere were 1682 encounters involving 54 primary care providers from January until May 31, 2019. In intervention clinics, the odds of any antibiotic prescription was reduced 22% (adjusted Odds Ratio (OR) = 0.78; 95% Confidence Interval (CI) = 0.64.0.96). The odds that a delay in filling a prescription was recommended was increased (adjusted OR=2.29; 95% CI=1.37, 3.83), while prescription durations greater than 7 days were reduced (adjusted OR=0.24; 95% CI=0.13, 0.43). Recommended antibiotic use was similar in control (85.4%) and intervention clinics (91.8%, p=0.37).

conclusionsA community-based, primary care provider-focused antimicrobial stewardship intervention was associated with a reduced likelihood of antibiotic prescriptions for respiratory and urinary infections, an increase in delayed prescriptions, and reduced prescription durations.

trial registrationclinicaltrials.gov ( NCT03517215 ).

Indexed as

Antimicrobial StewardshipRespiratory Tract InfectionsAdultAnti-Bacterial AgentsHumansOntarioPractice Patterns, Physicians'Primary Health CareAnti-Bacterial AgentsAntimicrobial stewardshipControlled trialPrimary care

Identifiers

PMID34525972
PMCPMC8442308

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.