Personalized Prescription Feedback Using Routinely Collected Data to Reduce Antibiotic Use in Primary Care: A Randomized Clinical Trial

Importance Feedback interventions using routinely collected health data might reduce antibioticuse nationwide without requiring the substantial resources and structural efforts of other antibioticstewardship programs. Objective To determine if quarterly antibioticprescription feedback over 2 years reduces antibioticuse when implemented in a complex health care system. Design, Setting, and Participants Pragmatic randomized trial using routinely collected claims data on 2900 primary care physicians with the highest antibioticprescription rates in Switzerland. Interventions Physicians were randomized to quarterly updated personalized antibioticprescription feedback over 2 years (n = 1450) or usual care (n = 1450). Feedback was provided both by mail and online from October 2013 to October 2015 and was supported by an initial 1-time provision of evidence-based guidelines. Main Outcomes and Measures The primary outcome was the prescribed defined daily doses(DDD) of any antibioticto any patient per 100 consultations in the first year analyzed by intention-to-treat. We further analyzed prescriptions of specific antibiotics, age groups, and sex for the first and second year to investigate persistency of effects over time. Results The 2900 physicians had 10 660 124 consultations over 2 years of follow-up, prescribed 1 175 780 packages of antibioticswith 10 290 182 DDD. Physicians receiving feedback prescribed the same amount of antibioticsto all patients in the first year (between-group difference, 0.81%; 95% CI, −2.56% to 4.30%; P  = .64) and second year (between-group difference, −1.73%; 95% CI, −5.07% to 1.72%; P  = .32) compared with the control group. Prescribing to children aged 6 to 18 years was −8.61% lower in the feedback than in the control group in the first year (95% CI, −14.87% to −1.90%; P  = .01). This difference diminished in the second year (between-group difference, −4.10%; 95% CI, −10.78% to 3.07%; P  = .25). Physicians receiving feedback prescribed fewer antibioticsto adults aged 19 to 65 years in the second year (between-group difference, −4.59%; 95% CI, −7.91% to −1.16%; P Conclusions and Relevance This nationwide antibioticstewardship program with routine feedback on antibioticprescribing was not associated with a change of antibioticuse. In older children, adolescents, and younger adults less antibioticswere prescribed, but not consistently over the entire intervention period. Trial Registration clinicaltrials.gov Identifier:NCT01773824