Episode 309: 308. Mailed feedback to Primary Care Physicians on Antibiotic Prescribing

https://www.bmj.com/content/385/bmj-2024-079329



Overprescription of antibiotics by primary care clinicians is a major modifiable driver of antibiotic resistance. Evidence suggests that peer-comparison feedback can reduce antibiotic overprescription, but the optimal content and delivery of such feedback is unclear

Researchers randomized 5000 family physicians in Ontario, Canada, to receive either mailed feedback (with data on individual prescribing rates compared with peers' prescribing rates, plus educational information on optimal prescribing) or no mailed feedback (control group).

Clinicians in the intervention group were randomized further to (a) receiving personalized prescribing data that were adjusted, versus not adjusted, for case mix, and (b) receiving information on potential harms of antibiotics, versus not receiving such information.

Compared with controls, the intervention group had significantly lower mean rates of overall antibiotic prescribing (59 vs. 56 prescriptions per 1000 patient visits; relative rate, 0.95), apparently unnecessary antibiotic prescriptions (e.g., for viral illnesses; RR, 0.89), long-duration antibiotic prescriptions (RR, 0.85), and broad-spectrum antibiotic prescriptions (RR, 0.94) in the first 6 months after the mailings.

Only 18% of a sample of intervention physicians confirmed receipt of feedback letters.

Tells me—there has to be a personal connection. If you think this is you then you are likely to be make a change but with only 18% people confirming receipt is tells me

Physicians are burnt out—I refuse to believe they don’t care but rather they are drowning