Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Public Health Ontario, Toronto, Ontario, Canada.
Clin Infect Dis. 2021 Sep 15;73(6):e1296-e1304. doi: 10.1093/cid/ciab256.
Antibiotic overprescribing in long-term care settings is driven by prescriber preferences and is associated with preventable harms for residents. We aimed to determine whether peer comparison audit and feedback reporting for physicians reduces antibiotic overprescribing among residents.
We employed a province wide, difference-in-differences study of antibiotic prescribing audit and feedback, with an embedded pragmatic randomized controlled trial (RCT) across all long-term care facilities in Ontario, Canada, in 2019. The study year included 1238 physicians caring for 96 185 residents. In total, 895 (72%) physicians received no feedback; 343 (28%) were enrolled to receive audit and feedback and randomized 1:1 to static or dynamic reports. The primary outcomes were proportion of residents initiated on an antibiotic and proportion of antibiotics prolonged beyond 7 days per quarter.
Among all residents, between the first quarter of 2018 and last quarter of 2019, there were temporal declines in antibiotic initiation (28.4% to 21.3%) and prolonged duration (34.4% to 29.0%). Difference-in-differences analysis confirmed that feedback was associated with a greater decline in prolonged antibiotics (adjusted difference -2.65%, 95% confidence interval [CI]: -4.93 to -.28%, P = .026), but there was no significant difference in antibiotic initiation. The reduction in antibiotic durations was associated with 335 912 fewer days of treatment. The embedded RCT detected no differences in outcomes between the dynamic and static reports.
Peer comparison audit and feedback is a pragmatic intervention that can generate small relative reductions in the use of antibiotics for prolonged durations that translate to large reductions in antibiotic days of treatment across populations. Clinical Trials Registration. NCT03807466.
长期护理机构中抗生素的过度开具是由医生的偏好驱动的，这与居民可预防的伤害有关。我们旨在确定医生的同行比较审计和反馈报告是否能减少居民中抗生素的过度开具。
我们在加拿大安大略省进行了一项全省范围内的抗生素处方审计和反馈的差异差异研究，并在 2019 年对所有长期护理机构进行了嵌入式实用随机对照试验 (RCT)。研究年度包括 1238 名照顾 96185 名居民的医生。总共有 895 名（72%）医生没有收到反馈；343 名（28%）医生被纳入接受审计和反馈，并以 1:1 的比例随机分为静态或动态报告。主要结果是开始使用抗生素的居民比例和每季度抗生素延长超过 7 天的比例。
在所有居民中，从 2018 年第一季度到 2019 年最后一个季度，抗生素的使用开始（28.4%降至 21.3%）和延长时间（34.4%降至 29.0%）呈现出时间上的下降。差异差异分析证实，反馈与延长抗生素的使用减少有关（调整后的差异-2.65%，95%置信区间[CI]：-4.93 至-0.28%，P=0.026），但抗生素的使用开始没有显著差异。抗生素持续时间的减少与治疗天数减少 335912 天有关。嵌入式 RCT 未发现动态和静态报告之间的结果有差异。
同行比较审计和反馈是一种实用的干预措施，可以在抗生素使用时间的相对减少方面产生较小的影响，从而在人群中减少抗生素治疗的天数。临床试验注册。NCT03807466。
