- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03488121
Randomized Controlled Study to Incentivize Doctors for Appropriate Use of Medical Care in NL
When Less is More: A Real World Randomized Controlled Study to Incentivize Doctors for Appropriate Use of Medical Care in NL
Study Overview
Status
Intervention / Treatment
Detailed Description
The study will employ a prospective, cluster randomized controlled trial design and will involve fee-for-service family physicians in NL. Randomization will be performed at the clinic level and stratified by clinic size. Clinics will be randomized into one of four groups: i) the control group will not receive any incentive; ii) the poster group will receive posters only; iii) the letter group will receive thank-you letters only; and iv) the double incentive group will receive both posters and thank-you letters. The number of clinics in each group will be equal.
The study will test two interventions. First, it will examine the impact of placing a poster in a physician's examination room containing motivational messages about the important roles that doctors and patients can play in reducing unnecessary care. The second incentive will involve sending thank-you letters to physicians aiming to encourage them to following Choosing Wisely's recommendations by recognizing their contribution in reducing unnecessary care. The study will focus on physicians' prescribing of antibiotics and serum ferritin tests. The posters will be designed to contain inspirational messages and pictures that highlight the important and unique roles that physicians and patients play in reducing unnecessary care and health care costs. These will be displayed in physicians' examination rooms so that they are salient to doctors and patients. The thank-you letters will contain two types of information: the changes in the rates of antibiotics and serum ferritin tests ordered since Choosing Wisely NL's introduction and a thank you message from the NL Medical Association (NLMA). These will be sent to doctors quarterly (to reinforce the message) with the changes in the rates of antibiotics and serum ferritin tests ordered being updated.
These incentives will be delivered over a 12-month period. The researchers will measure changes in the study outcomes at the end of this 12-month intervention period. Further, to examine if the effects of the intervention are sustained, these changes will be evaluated again 6 months after the withdrawal of incentives. The two incentives will be delivered via NLMA to its member family physicians. As such, physicians will be blinded to this study (i.e., they would not know that these posters and letters are part of a study). The study will focus on fee-for-service physicians in NL as data on the number of patients are only available for these physicians.
Study Type
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Newfoundland and Labrador
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St. John's, Newfoundland and Labrador, Canada, A1B 3V6
- School of Pharmacy, Memorial University of Newfoundland
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- ADULT
- OLDER_ADULT
- CHILD
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- All Fee-For-Service family physicians registered with the NL Medical Association
Exclusion Criteria:
- Salary based family physicians
Study Plan
How is the study designed?
Design Details
- Primary Purpose: HEALTH_SERVICES_RESEARCH
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: SINGLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Poster Only
This arm will only receive motivational posters.
|
Posters contain inspirational messages and pictures highlighting the important and unique roles that patients and physicians can play in reducing unnecessary care and health care costs.
These posters will be placed in physician offices.
|
EXPERIMENTAL: Thank-you Letter Only
This arm will only receive thank-you letters.
|
Physicians will be sent thank-you letters containing changes in the rates of antibiotics and serum ferritin tests ordered since introduction of Choosing Wisely NL and a thank-you message from the NL Medical Association.
|
EXPERIMENTAL: Double Incentive
This arm will receive both motivational posters and thank-you letters.
|
Posters contain inspirational messages and pictures highlighting the important and unique roles that patients and physicians can play in reducing unnecessary care and health care costs.
These posters will be placed in physician offices.
Physicians will be sent thank-you letters containing changes in the rates of antibiotics and serum ferritin tests ordered since introduction of Choosing Wisely NL and a thank-you message from the NL Medical Association.
|
NO_INTERVENTION: Control
This arm will not receive any intervention.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Rate of antibiotic prescriptions
Time Frame: 12 months
|
Rate of antibiotic prescriptions will be calculated as the number of antibiotic prescriptions per patient.
|
12 months
|
Rate of ordering of serum ferritin tests
Time Frame: 12 months
|
Rate of serum ferritin tests ordered will be calculated as the number of serum ferritin tests ordered per patient.
|
12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Cost savings from implementing the incentives
Time Frame: 12 months
|
Cost savings for 'Poster Only' arm: To estimate cost savings for this arm, reductions in prescription of antibiotics and serum ferritin tests in this arm (relative to control arm) estimated by the RCT will be converted into monetary values using pricing data from the literature. Cost savings for 'Thank-you Letter Only' arm: To estimate cost savings for this arm, reductions in prescription of antibiotics and serum ferritin tests in this arm (relative to control arm) estimated by the RCT will be converted into monetary values using pricing data from the literature. Cost savings for 'Double Incentive' arm: To estimate cost savings for this arm, reductions in prescription of antibiotics and serum ferritin tests in this arm (relative to control arm) estimated by the RCT will be converted into monetary values using pricing data from the literature. Total cost savings will then be compared with total cost of implementing the associated incentive to estimate total net cost savings. |
12 months
|
Collaborators and Investigators
Investigators
- Principal Investigator: Hai Nguyen, PhD, Memorial University of Newfoundland
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ANTICIPATED)
Study Completion (ANTICIPATED)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- 2017.282
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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