Evidence map›Paper›PMID 39285305›Full record

Trial reportImplementation science : IS2024

Process evaluation of two large randomized controlled trials to understand factors influencing family physicians' use of antibiotic audit and feedback reports.

Jennifer Shuldiner, Meagan Lacroix, Marianne Saragosa, Catherine Reis, Kevin L Schwartz, Sharon Gushue, Valerie Leung, Jeremy Grimshaw, Michael Silverman, Kednapa Thavorn and 12 more

2 registry-linked trialsAbstract readRandomized Controlled TrialPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Implementation science : IS, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing 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.

NCT04594200 nacompletednot on this map

Do Peer-comparisons, Emphasis on Harms, and/or Inclusion of Viral Prescription Pad Resources Increase Responsiveness to Feedback About Antibiotic Prescribing in Primary Care (PHO Trial)

TypeinterventionalSponsorWomen's College HospitalRan2022 to 2023Enrolled5,107ConditionsInfectionArmsAudit and Feedback (A&F)
NCT05044052 nacompletednot on this map

Do Peer-comparisons, Emphasis on Harms, and/or Inclusion of Viral Prescription Pad Resources Increase Responsiveness to Feedback About Antibiotic Prescribing in Primary Care: Protocol for Two Linked Trials With Embedded Process Evaluations (OH Trial)

TypeinterventionalSponsorWomen's College HospitalRan2021 to 2022Enrolled3,379ConditionsInfectionArmsEmphasis on the Choosing Wisely Viral Prescription Pad
3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Trial
  2. Article
  3. Article
  4. Article
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

22 authors.

Jennifer ShuldinerWomen's College Hospital Institute of Virtual Care and Systems Solutions, Women's College Hospital, Toronto, ON, Canada. Jennifer.shuldiner@wchospital.ca.ORCID 0000-0003-2240-6274
Meagan LacroixWomen's College Hospital Institute of Virtual Care and Systems Solutions, Women's College Hospital, Toronto, ON, Canada.
Marianne SaragosaLunenfeld-Tanenbaum Research Institute, Sinai Health Catherine Reis, Women's College Hospital, Toronto, ON, Canada.
Catherine ReisWomen's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
Kevin L SchwartzICES, Toronto, ON, Canada.
Sharon GushueOntario Health, Toronto, ON, Canada.
Valerie LeungPublic Health Ontario, Toronto, ON, Canada.
Jeremy GrimshawOttawa Hospital Research Institute, Ottawa, ON, Canada.
Michael SilvermanDepartment of Medicine and Infectious Diseases, Division of Infectious Diseases, Western University, London, ON, Canada.
Kednapa ThavornOttawa Hospital Research Institute, Ottawa, ON, Canada.
Jerome A LeisSunnybrook Health Sciences Centre, Toronto, ON, Canada.
Michael KiddNuffield Department of Primary Care Health Sciences, The University of Oxford, Oxford, UK.
Nick DanemanICES, Toronto, ON, Canada.
Mina TradousWomen's College Hospital Institute of Virtual Care and Systems Solutions, Women's College Hospital, Toronto, ON, Canada.
Bradley LangfordPublic Health Ontario, Toronto, ON, Canada.
Andrew M MorrisMount Sinai Hospital, Toronto, ON, Canada.
Jonathan LamOntario Health Ontario, Toronto, Canada.
Gary GarberDepartment of Medicine and Department of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
Jamie BrehautOttawa Hospital Research Institute, Ottawa, ON, Canada.
Monica TaljaardOttawa Hospital Research Institute, Ottawa, ON, Canada.
Michelle GreiverDepartment of Family and Community Medicine, University of Toronto, Toronto, Canada.
Noah Michael IversInstitute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

Funding

Canadian Institute of Health Research 398514).
6 · The paper itself

Abstract

backgroundUnnecessary antibiotic prescriptions in primary care are common and contribute to antimicrobial resistance in the population. Audit and feedback (A&F) on antibiotic prescribing to primary care can improve the appropriateness of antibiotic prescribing, but the optimal approach is uncertain. We performed two pragmatic randomized controlled trials of different approaches to audit and feedback. The trial results showed that A&F was associated with significantly reducing antibiotic prescribing. Still, the effect size was small, and the modifications to the A&F interventions tested in the trials were not associated with any change. Herein, we report a theory-informed qualitative process evaluation to explore potential mechanisms underlying the observed effects.

methodsOntario family physicians in the intervention arms of both trials who were sent A&F letters were invited for one-on-one interviews. Purposive sampling was used to seek variation across interested participants in personal and practice characteristics. Qualitative analysis utilized inductive and deductive techniques informed by the Clinical Performance Feedback Intervention Theory.

resultsModifications to the intervention design tested in the trial did not alter prescribing patterns beyond the changes made in response to the A&F overall for various reasons. Change in antibiotic prescribing in response to A&F depended on whether it led to the formation of specific intentions and whether those intentions translated to particular behaviours. Those without intentions to change tended to feel that their unique clinical context was not represented in the A&F. Those with intentions but without specific actions taken tended to express a lack of self-efficacy for avoiding a prescription in contexts with time constraints and/or without an ongoing patient relationship. Many participants noted that compared to overall prescribing, A&F on antibiotic prescription duration was perceived as new information and easily actionable.

conclusionOur findings indicate that contextual factors, including the types of patients and the setting where they are seen, affect how clinicians react to audit and feedback. These results suggest a need to test tailored feedback reports that reflect the context of how, where, and why physicians prescribe antibiotics so that they might be perceived as more personal and more actionable.

trial registrationClinical Trial registration IDs: NCT04594200, NCT05044052.

Indexed as

Anti-Bacterial AgentsPractice Patterns, Physicians'FeedbackFemaleHumansInappropriate PrescribingMaleMedical AuditOntarioPhysicians, FamilyPrimary Health CareQualitative ResearchAnti-Bacterial AgentsAntibioticsAudit and feedbackProcess evaluation

Identifiers

PMID39285305
PMCPMC11403851

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

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.