Glinz, Dominik; Mc Cord, Kimberly A; Moffa, Giusi; Aghlmandi, Soheila; Saccilotto, Ramon; Zeller, Andreas; Widmer, Andreas F; Bielicki, Julia; Kronenberg, Andreas; Bucher, Heiner C (2021). Antibiotic prescription monitoring and feedback in primary care in Switzerland: Design and rationale of a nationwide pragmatic randomized controlled trial. Contemporary clinical trials communications, 21, p. 100712. Elsevier 10.1016/j.conctc.2021.100712
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Introduction
Antibiotic consumption is highest in primary care, and antibiotic overuse furthers antimicrobial resistance. In our recently published pilot-RCT, we used monthly aggregated claims data to provide personalized antibiotic prescription feedback to general practitioners (GPs). The pilot-RCT has shown that personalized prescription feedback is a feasible and promising low-cost intervention to reduce antibiotic prescribing. Here, we describe the rationale and design of the follow-up RCT with 3426 GPs in Switzerland. We now have access to pseudonymized patient-level data from routinely collected health insurance data of the three largest health insurers in Switzerland.
Methods and analysis
1713 GPs randomized to the intervention group received once evidence-based treatment guidelines at the beginning, including region-specific antibiotic resistance information from the community and personalized feedback of their antibiotic prescribing, followed by quarterly personalized prescription feedback for two years. The first and the last mailings were sent out in December 2017 and September 2019, respectively. The 1713 GPs randomized to the control group were not notified about the study and they received no guidelines and no prescription feedback. The personalized prescription feedbacks and the analyses of the primary and secondary outcomes are entirely based on pseudonymized patient-level data from routinely collected health insurance data. The primary outcome is prescribed antibiotics per 100 patient consultations during the second year of intervention. The secondary outcomes include antibiotic use during the entire two-year trial period, use of broad-spectrum antibiotics, hospitalization rates (all-cause and infection-related), and antibiotic use in different age groups. If the feedback intervention proves to be efficacious, the intervention could be continued systemwide.
Ethics and dissemination
The trial is publicly funded by the Swiss National Science Foundation (SNSF, grant number 407240_167066). The trial was approved by the ethics committee "Ethikkommission Nordwest-und Zentralschweiz" (EKNZ Project-ID 2017-00888). Results will be disseminated in peer-reviewed journals and international conferences.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Service Sector > Institute for Infectious Diseases |
UniBE Contributor: |
Kronenberg, Andreas Oskar |
Subjects: |
500 Science > 570 Life sciences; biology 600 Technology > 610 Medicine & health |
ISSN: |
2451-8654 |
Publisher: |
Elsevier |
Language: |
English |
Submitter: |
Andreas Oskar Kronenberg |
Date Deposited: |
24 Jan 2022 13:42 |
Last Modified: |
05 Dec 2022 16:01 |
Publisher DOI: |
10.1016/j.conctc.2021.100712 |
PubMed ID: |
33665467 |
Uncontrolled Keywords: |
Antibiotics Antimicrobial resistance CI, confidence interval CONSORT, consolidated standards of reporting trials Claims DRG, Diagnosis Related Groups EKNZ, Ethikkommission Nordwest-und Zentralschweiz FMH, Foederatio Medicorum Helveticorum GP, general practitioners HRA, Human Research Act HRO, Human Research Ordinance Health-system level Hospitalization Low-cost intervention Prescription feedback Primary care RCT, randomized controlled trials Routinely collected patient data ZSR, Zentralregisternummer |
BORIS DOI: |
10.48350/163879 |
URI: |
https://boris.unibe.ch/id/eprint/163879 |
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