Implementing an audit and feedback cycle to improve adherence to the Choosing Wisely Canada recommendations: clustered randomized trail
Tóm tắt
Audit and Feedback (A&F), a strategy aimed at promoting modified practice through performance feedback, is a method to change provider behaviour and reduce unnecessary medical services. This study aims to assess the use of A&F to reduce antibiotic prescribing for viral infections and antipsychotic prescribing to patients with dementia. Clustered randomized trial of 239 primary care providers in Manitoba, Canada, participating in the Manitoba Primary Care Research Network. Forty-six practices were randomly assigned to one of three groups: control group, intervention 1 (recommendations summary), intervention 2 (recommendations summary and personalized feedback). We assessed prescribing rates prior to the intervention (2014/15), during and immediately after the intervention (2016/17) and following the intervention (2018/19). Physician characteristics were assessed. Between 2014/15–2016/17, 91.6% of providers in intervention group 1 and 95.9% of providers in intervention group 2 reduced their antibiotic and antipsychotic prescribing rate by ≥ 1 compared to the control group (77.6%) (p-value 0.0073). This reduction was maintained into 2018/19 at 91.4%. On multivariate regression alternatively funded providers had 2.4 × higher odds of reducing their antibiotic prescribing rate compared to fee-for-service providers. In quantile regression of providers with a reduction in antibiotic prescribing, alternatively funded (e.g. salaried or locum) providers compared to fee-for-service providers were significant at the 80th quantile. Both A&F and recommendation summaries sent to providers by a trusted source reduced unnecessary prescriptions. Our findings support further scale up of efforts to engage with primary care practices to improve care with A&F. ClinicalTrials.gov NCT05385445, retrospectively registered, 23/05/2022.
Tài liệu tham khảo
Brownlee S, Chalkidou K, Doust J, Elshaug AG, Glasziou P, Heath I, et al. Evidence for overuse of medical services around the world. Lancet. 2017;390(10090):156–68. https://doi.org/10.1016/S0140-6736(16)32585-5.
Canadian Institute for Health Information. Unnecessary Care in Canada. Ottawa, ON: CIHI; 2017. Accessed Aug 26, 2021 from https://www.cihi.ca/sites/default/files/document/choosing-wisely-baseline-report-en-web.pdf
Lyu H, Xu T, Brotman D, Mayer-Blackwell B, Cooper M, Daniel M, et al. Overtreatment in the United States. PLoS One. 2017;12(9):e0181970. https://doi.org/10.1371/journal.pone.0181970.
Ferri M, Ranucci E, Romagnoli P, Giaccone V. Antimicrobial resistance: a global emerging threat to public health systems. Crit Rev Food Sci Nutr. 2017;57(13):2857–76. https://doi.org/10.1080/10408398.2015.1077192.
Singer A, Kosowan L, Katz A, Jolin-Dahel K, Appel K, Lix LM. Prescribing and testing by primary care providers to assess adherence to the Choosing Wisely Canada recommendations: a retrospective cohort study. CMAJ Open. 2018;6(4):E603–10. https://doi.org/10.9778/cmajo.20180053.
Singer A, Fanella S, Kosowan L, Falk J, Dufault B, Hamilton K, et al. Informing antimicrobial stewardship: factors associated with inappropriate antimicrobial prescribing in primary care. Fam Pract. 2018;35(4):455–60. https://doi.org/10.1093/fampra/cmx118.
Ruth C, Fanella S, Raymond C, Dragan R, Prior H, Dik N, et al. Outpatient antibiotic prescribing by Manitoba clinicians. Winnipeg, MB: Manitoba Centre for Health Policy. 2021. Accessed Nov 15, 2021 from http://mchp-appserv.cpe.umanitoba.ca/reference/ASP_Report_Web.pdf
Choosing Wisely Canada. About Choosing Wisely Canada. Accessed Aug 27, 2021 from https://choosingwiselycanada.org/about/
College of Family Physicians of Canada. Thirteen Things Physicians and Patients should Question. Choosing Wisely Canada; (updated July 2020). Accessed Aug 26, 2021 from https://choosingwiselycanada.org/family-medicine/
Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein E, Hicks L, et al. Infectious Diseases Society of America. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012;54(8):e72–112. https://doi.org/10.1093/cid/cir1043.
Smith SS, Evans CT, Tan BK, Chandra RK, Smith SB, Kern RC. National burden of antibiotic use for adult rhinosinusitis. J Allergy Clin Immunol. 2013;132(5):P1230–2. https://doi.org/10.1016/j.jaci.2013.07.009.
Desrosiers M, Evans GA, Keith PL, Wright ED, Kaplan A, Bouchard J, et al. Canadian clinical practice guidelines for acute and chronic rhinosinusitis. Allergy Asthma Clin Immunol. 2011;40(Suppl 2):S99-193.
Low D. Reducing antibiotic use in influenza: challenges and rewards. Clin Microbiol Infect. 2008;14(4):298–306. https://doi.org/10.1111/j.1469-0691.2007.01910.x.
Hirschmann JV. Antibiotics for common respiratory tract infections in adults. Arch Intern Med. 2002;162(3):256–64. https://doi.org/10.1001/archinte.162.3.256.
Canadian Geriatrics Society. Five things physicians and patients should question. Choosing Wisely Canada; (updated November 2020). Accessed Aug 26, 2021 from https://choosingwiselycanada.org/geriatrics/
Madhusoodanan S, Shah P, Brenner R, Gupta S. Pharmacological treatment of the psychosis of Alzheimer’s disease: what it the best approach? CNS Drugs. 2007;21:101–15. https://doi.org/10.2165/00023210-200721020-00002.
Gill SS, Bronskill SE, Normand SL, Anderson GM, Sykora K, Lam K, et al. Antipsychotic drug use and mortality in older adults with dementia. Ann Intern Med. 2007;146(11):775–86. https://doi.org/10.7326/0003-4819-146-11-200706050-00006.
Lee PE, Gill SS, Freedman M, Bronskill SE, Hillmer MP, Rochon PA. Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia: systematic review. BMJ. 2004;329(7457):75–78. https://www.jstor.org/stable/25458179
Rochon PA, Normand SL, Gomes T, Gill SS, Anderson GM, Melo M, et al. Antipsychotic therapy and short-term serious events in older adults with dementia. Arch Intern Med. 2008;168(10):1090–6. https://doi.org/10.1001/archinte.168.10.1090.
Flottorp SA, Jamtvedt G, Gibis B, Mckee M. Policy Summary 3: Using Audit and Feedback to Health Professionals to Improve the Quality and Safety of Health Care. WHO Regional Office for Europe: Copenhagen, Denmark. ISSN 2077–1584. Accessed Aug 27, 2021 from https://www.euro.who.int/__data/assets/pdf_file/0003/124419/e94296.pdf
Ivers NM, Taljaard M, Giannakeas V, Reis C, Mulhall CL, Lam JMC, et al. Effectiveness of confidential reports to physicians on their prescribing of antipsychotic medications in nursing homes. Implement Sci Commun. 2020;1:30–44. https://doi.org/10.1186/s43058-020-00013-9.
Sykes MJ, McAnuff J, Kolehmainen N. When is audit and feedback effective in dementia care? a systematic review. Int J Nurs Stud. 2018;79:27–35. https://doi.org/10.1016/j.ijnurstu.2017.10.013.
Hemkens LG, Saccilotto R, Reyes SL, Glinz D, Zumbrunn T, Grolimund O, et al. Personalized prescription feedback using routinely collected data to reduce antibiotic use in primary care: a randomized clinical trial. JAMA Intern Med. 2017;177(2):176–83. https://doi.org/10.1001/jamainternmed.2016.8040.
Hallsworth M, Chadborn T, Sallis A, Sanders M, Berry D, Greaves F, et al. Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomised controlled trial. Lancet. 2016;387(10029):1743–52. https://doi.org/10.1016/S0140-6736(16)00215-4.
Meeker D, Linder JA, Fox CR, Friedberg MW, Persell SD, Goldstein NJ, et al. Effect of behavioral interventions on inappropriate antibiotic prescribing among primary care practices: A randomized clinical trial. JAMA. 2016;315(6):562–70. https://doi.org/10.1001/jama.2016.0275.
Ivers N, Gro J, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012;6:CD000259. https://doi.org/10.1002/14651858.CD000259.pub3.
Whittington MD, Ho PM, Helfrich CD. Recommendations for the use of audit and feedback to de-implement low-value care. Am J Med Qual. 2019;34(4):409–11. https://doi.org/10.1177/1062860618824153.
Kaki R, Elligsen M, Walker S, Simor A, Palmay L, Daneman N. Impact of antimicrobial stewardship in critical care: a systematic review. J Antimicrob Chemother. 2011;66(6):1223–30. https://doi.org/10.1093/jac/dkr137.
Newland JG, Stach LM, De Lurgio SA, Hedican E, Yu D, Herigon JC, et al. Impact of a prospective-audit-with-feedback antimicrobial stewardship program at a children’s hospital. J Pediatric Infect Dis Soc. 2012;1(3):179–86. https://doi.org/10.1093/jpids/pis054.
Coon JT, Abbott R, Rogers M, Whear R, Pearson S, Lang I, Cartmell N, Stein K. Interventions to reduce inappropriate prescribing of antipsychotic medications in people with dementia resident in care homes: a systematic review. J Am Med Dir Assoc. 2014;15(10):706–18. https://doi.org/10.1016/j.jamda.2014.06.012.