Improving antibiotic prescribing for pediatric acute respiratory tract infections: A cluster randomized trial to evaluate individual versus clinic feedback

Herbert W Clegg, Stephen J Ezzo, Kelly B Flett, William E Anderson, Herbert W Clegg, Stephen J Ezzo, Kelly B Flett, William E Anderson

Abstract

Objective: To assess the effect of individual compared to clinic-level feedback on guideline-concordant care for 3 acute respiratory tract infections (ARTIs) among family medicine clinicians caring for pediatric patients.

Design: Cluster randomized controlled trial with a 22-month baseline, 26-month intervention period, and 12-month postintervention period.

Setting and participants: In total, 26 family medicine practices (39 clinics) caring for pediatric patients in Virginia, North Carolina, and South Carolina were selected based upon performance on guideline-concordance for 3 ARTIs, stratified by practice size. These were randomly allocated to a control group (17 clinics in 13 practices) or to an intervention group (22 clinics in 13 practices).

Interventions: All clinicians received an education session and baseline then monthly clinic-level rates for guideline-concordant antibiotic prescribing for ARTIs: upper respiratory tract infection (URI), acute bacterial sinusitis (ABS), and acute otitis media (AOM). For the intervention group only, individual clinician performance was provided.

Results: Both intervention and control groups demonstrated improvement from baseline, but the intervention group had significantly greater improvement compared with the control group: URI (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.37-1.92; P < 0.01); ABS (OR, 1.45; 95% CI, 1.11-1.88; P < 0.01); and AOM (OR, 1.59; 95% CI, 1.24-2.03; P < 0.01). The intervention group also showed significantly greater reduction in broad-spectrum antibiotic prescribing percentage (BSAP%): odds ratio 0.80, 95% CI 0.74-0.87, P < 0.01. During the postintervention year, gains were maintained in the intervention group for each ARTI and for URI and AOM in the control group.

Conclusions: Monthly individual peer feedback is superior to clinic-level only feedback in family medicine clinics for 3 pediatric ARTIs and for BSAP% reduction.

Trial registration: ClinicalTrials.gov identifier: NCT04588376, Improving Antibiotic Prescribing for Pediatric Respiratory Infection by Family Physicians with Peer Comparison.

Keywords: acute; antibiotic; antimicrobial; audit; cluster; feedback; infections; pediatric; peer; randomized; respiratory; stewardship; tract; trial.

© The Author(s) 2021.

Figures

Fig. 1.
Fig. 1.
Flow diagram for clinic selection process.
Fig. 2.
Fig. 2.
Proportion of illness encounters with appropriate prescribing for the intervention and control groups during the 3 periods studied.

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Source: PubMed

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