title: Personalized prescription feedback to reduce antibiotic overuse in primary care: rationale and design of a nationwide pragmatic randomized trial.
abstract: Antimicrobial resistance has become a serious worldwide public health problem and is associated with antibiotic overuses. Whether personalized prescription feedback to high antibiotic prescribers using routinely collected data can lower antibiotic use in the long run is unknown.
  
  
  
  We describe the design and rationale of a nationwide pragmatic randomized controlled trial enrolling 2900 primary care physicians in Switzerland with high antibiotic prescription rates based on national reimbursement claims data. About 1450 physicians receive quarterly postal and online antibiotic prescription feedback over 24 months allowing a comparison of the individual prescription rates with peers. Initially, they also receive evidence based treatment guidelines. The 1450 physicians in the control group receive no information. The primary outcome is the amount of antibiotics prescribed over a one year-period, measured as defined daily doses per 100 consultations. Other outcomes include the amount of antibiotics prescribed to specific age groups (<6, 6 to 18, 19 to 65, >65 years), to male and female patients, in addition to prescriptions of specific antibiotic groups. Further analyses address disease-specific quality indicators for outpatient antibiotic prescriptions, the acceptance of the intervention, and the impact on costs.
  
  
  
  This trial investigates whether continuous personalized prescription feedback on a health system level using routinely collected health data reduces antibiotic overuse. The feasibility and applicability of a web-based interface for communication with primary care physicians is further assessed.
  
  
  
  ClinTrials.gov NCT01773824 (Date registered: August 24, 2012).
authors.affiliation: Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, CH-4031, Basel, Switzerland.
authors.forename: Lars G
authors.initials: LG
authors.lastname: Hemkens
authors.affiliation: Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, CH-4031, Basel, Switzerland.
authors.forename: Ramon
authors.initials: R
authors.lastname: Saccilotto
authors.affiliation: Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, CH-4031, Basel, Switzerland.
authors.forename: Selene L
authors.initials: SL
authors.lastname: Reyes
authors.affiliation: Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, CH-4031, Basel, Switzerland.
authors.forename: Dominik
authors.initials: D
authors.lastname: Glinz
authors.affiliation: Clinical Trial Unit, Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zumbrunn
authors.affiliation: SASIS AG, Solothurn, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Grolimund
authors.affiliation: Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, CH-4031, Basel, Switzerland.
authors.forename: Viktoria
authors.initials: V
authors.lastname: Gloy
authors.affiliation: Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, CH-4031, Basel, Switzerland.
authors.forename: Heike
authors.initials: H
authors.lastname: Raatz
authors.affiliation: Division of Infectious Diseases and Hospital Hygiene, University Hospital Basel, Basel, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Widmer
authors.affiliation: Centre for Primary Health Care, University of Basel, Basel, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Zeller
authors.affiliation: Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, CH-4031, Basel, Switzerland. heiner.bucher@usb.ch.
authors.forename: Heiner C
authors.initials: HC
authors.lastname: Bucher
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005246:Feedback; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D010820:Physicians; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D064792:Pragmatic Clinical Trials as Topic; D000067490:Prescription Drug Overuse / Q000517:prevention & control*; D011320:Primary Health Care; D019984:Quality Indicators, Health Care; D016032:Randomized Controlled Trials as Topic; D013557:Switzerland; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Prescription feedback; Primary care; Routinely collected health data