A physician examining data on antibiotic prescribing trends, surrounded by elderly patients and prescription charts. The image should evoke a sense of urgency in reducing antibiotic overuse, with graphs showing downward trends. Physicians should appear thoughtful, engaged in quality improvement efforts.
Antibiotic overuse is a critical concern in healthcare, contributing to rising antibiotic resistance. A recent randomized controlled trial addressed this issue by sending feedback letters to primary care physicians in Ontario, Canada, to reduce unnecessary antibiotic prescriptions among patients aged 65 years and older. This initiative aimed to identify whether providing physicians with their prescribing rates compared to their peers would influence prescribing behaviors.
Feedback as a Behavioral Intervention
Physicians often overestimate the benefits of antibiotics while underestimating their potential harms. This trial employed behavioral science principles by using peer comparison to encourage better prescribing habits. Kevin L. Schwartz, the study’s lead investigator, emphasized, “We know that feedback can change behavior, but it was essential to understand which components of feedback work best.”
Measured Impact on Prescribing
The results were clear. Overall, the physicians who received feedback reduced their antibiotic prescribing rates by approximately 5% compared to the control group. This reduction persisted over six and 12 months following the intervention. The study revealed that unnecessary antibiotic prescriptions, prolonged durations, and the use of broad-spectrum antibiotics all decreased significantly.
The research team stated, “Our primary outcome showed an 11% relative reduction in unnecessary prescriptions and a 15% reduction in prolonged antibiotic use.” Importantly, no additional benefit was observed from the inclusion of warnings about antibiotic-associated harms. This suggests that peer comparison alone was sufficient to modify prescribing behavior.
Scalability and Implications for Healthcare
The findings point to the scalability of such feedback interventions. Schwartz commented, “We believe this type of feedback could be implemented on a larger scale across different regions. The data shows it is an effective and relatively low-cost method for improving antibiotic stewardship.”
The study’s design also explored other dimensions, such as adjusting feedback to account for case-mix differences, but this did not lead to significant changes in outcomes. Jerome A. Leis, another researcher on the team, remarked, “While case-mix adjustment didn’t change the outcomes significantly, it’s important to address physicians’ concerns that their patient population complexity is recognized.”
A Call for Routine Feedback in Primary Care
The trial concluded that regular audit and feedback should become a routine part of quality improvement initiatives in primary care. By consistently providing physicians with data about their prescribing habits in relation to their peers, healthcare systems can curb the over-prescription of antibiotics, a crucial step in combating the global threat of antibiotic resistance.
The research team remains optimistic. “This is just one step in our efforts to optimize antibiotic use,” Schwartz reflected. “With continued focus, we can protect patients from the dangers of antibiotic overuse while preserving the effectiveness of these vital drugs.”
Citation:
Schwartz KL, Shuldiner J, Langford BJ, et al. Mailed feedback to primary care physicians on antibiotic prescribing for patients aged 65 years and older: pragmatic, factorial randomised controlled trial. BMJ. 2024;385. doi:10.1136/bmj-2024-079329.
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