title: Personalized Prescription Feedback Using Routinely Collected Data to Reduce Antibiotic Use in Primary Care: A Randomized Clinical Trial.
abstract: Feedback interventions using routinely collected health data might reduce antibiotic use nationwide without requiring the substantial resources and structural efforts of other antibiotic stewardship programs.
  
  
  
  To determine if quarterly antibiotic prescription feedback over 2 years reduces antibiotic use when implemented in a complex health care system.
  
  
  
  Pragmatic randomized trial using routinely collected claims data on 2900 primary care physicians with the highest antibiotic prescription rates in Switzerland.
  
  
  
  Physicians were randomized to quarterly updated personalized antibiotic prescription feedback over 2 years (n = 1450) or usual care (n = 1450). Feedback was provided both by mail and online from October 2013 to October 2015 and was supported by an initial 1-time provision of evidence-based guidelines.
  
  
  
  The primary outcome was the prescribed defined daily doses (DDD) of any antibiotic to any patient per 100 consultations in the first year analyzed by intention-to-treat. We further analyzed prescriptions of specific antibiotics, age groups, and sex for the first and second year to investigate persistency of effects over time.
  
  
  
  The 2900 physicians had 10 660 124 consultations over 2 years of follow-up, prescribed 1 175 780 packages of antibiotics with 10 290 182 DDD. Physicians receiving feedback prescribed the same amount of antibiotics to all patients in the first year (between-group difference, 0.81%; 95% CI, -2.56% to 4.30%; P = .64) and second year (between-group difference, -1.73%; 95% CI, -5.07% to 1.72%; P = .32) compared with the control group. Prescribing to children aged 6 to 18 years was -8.61% lower in the feedback than in the control group in the first year (95% CI, -14.87% to -1.90%; P = .01). This difference diminished in the second year (between-group difference, -4.10%; 95% CI, -10.78% to 3.07%; P = .25). Physicians receiving feedback prescribed fewer antibiotics to adults aged 19 to 65 years in the second year (between-group difference, -4.59%; 95% CI, -7.91% to -1.16%; P < .01). Prescribing to other patient groups or of specific antibiotic types was not significantly different between groups.
  
  
  
  This nationwide antibiotic stewardship program with routine feedback on antibiotic prescribing was not associated with a change of antibiotic use. In older children, adolescents, and younger adults less antibiotics were prescribed, but not consistently over the entire intervention period.
  
  
  
  clinicaltrials.gov Identifier: NCT01773824.
authors.affiliation: Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland.
authors.forename: Lars G
authors.initials: LG
authors.lastname: Hemkens
authors.affiliation: Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
authors.forename: Ramon
authors.initials: R
authors.lastname: Saccilotto
authors.affiliation: Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland.
authors.forename: Selene Leon
authors.initials: SL
authors.lastname: Reyes
authors.affiliation: Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland.
authors.forename: Dominik
authors.initials: D
authors.lastname: Glinz
authors.affiliation: Clinical Trial Unit, University Hospital Basel, University of 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, University Hospital Basel, University of Basel, Basel, Switzerland.
authors.forename: Viktoria
authors.initials: V
authors.lastname: Gloy
authors.affiliation: Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland.
authors.forename: Heike
authors.initials: H
authors.lastname: Raatz
authors.affiliation: Division of Infectious Diseases and Hospital Hygiene, University Hospital Basel, University of Basel, Basel, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Widmer
authors.affiliation: Centre for Primary Health Care, University of Basel, University of Basel, Basel, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Zeller
authors.affiliation: Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland.
authors.forename: Heiner C
authors.initials: HC
authors.lastname: Bucher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005246:Feedback; D005260:Female; D006302:Health Services Research; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / 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; D013557:Switzerland
chemical_list: D000900:Anti-Bacterial Agents