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Routine feedback does not improve antibiotic use
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An antibiotic stewardship intervention program that offered personalized prescription feedback four times a year was not associated with a reduction in antibiotic use, according to results from a randomized clinical trial published in JAMA Internal Medicine.
“Antibiotic resistance is closely correlated with antibiotic use in primary care and is a major threat to public health,” Lars G. Hemkens, MD, MPH, from Basel Institute for Clinical Epidemiology and Biostatistics, and colleagues wrote.
“Feedback interventions using routinely collected health data might reduce antibiotic use nationwide without requiring the substantial resources and structural efforts of other antibiotic stewardship programs,” they added.
Hemkens and colleagues performed a nationwide randomized trial to investigate whether quarterly antibiotic prescription feedback reduced antibiotic use over a 2-year period. Using routinely collected claims data, the researchers identified 2,900 Swiss primary care physicians with the highest antibiotic prescribing rates, then randomly assigned them into one of two groups: controls (n = 1,450) or the feedback intervention group (n = 1,450). Between October 2013 and October 2015, feedback — supported by a one-time provision of evidence-based guidelines — was provided online or through mail.
According to the researchers, physicians who participated in the study conducted 10,660,124 consultations over the study duration and prescribed 10,290,182 defined daily doses of antibiotics. Antibiotic prescribing did not differ between physicians in either group in the first year (between-group difference, 0.81%; 95% CI, –2.56 to 4.3) and second year (between-group difference, –1.73%; 95% CI, –5.07 to 1.72;). Compared with the control group, physicians in the intervention group had an 8.61% lower prescription rate for children aged 6 to 18 years in the first year (95% CI, –14.87 to –1.9; P = .01); however, in the second year, this difference was reduced (between-group difference, –4.10%; 95% CI, –10.78 to 3.07).
In addition, fewer antibiotics were prescribed in the second year to adults aged 19 to 65 years by physicians in the intervention group (between-group difference, –4.59%; 95% CI, –7.91 to –1.16; P < .01). There was no significant difference in prescribing to other patient groups or of specific antibiotic types between the intervention and control groups.
“Quarterly personalized prescription feedback over 2 years combined with a 1-time provision of evidence-based guidelines does not reduce antibiotic use,” Hemkens and colleagues concluded. “Whether antibiotic use can be reduced in some patient groups ... remains to be shown. Given the low costs for implementation, more intense and better tailored prescription feedback approaches merit further evaluation and it should be shown whether they are associated with patient-relevant benefits and directly impact antibiotic resistance.” – by Alaina Tedesco
- Reference:
- Hemkens LG, et al. JAMA Intern Med. 2016;doi:10.1001/jamainternmed.2016.8040.
Disclosures: The Basel Institute for Clinical Epidemiology and Biostatistics was supported by Santésuisse, an umbrella association of Swiss social health insurers. One of the authors was a consultant for Novartis, and another author is an employee of SASIS AG, a company that provided the routinely collected health data for the study.