Tracking and Reporting

Gerber JS, et al. Durability of benefits of an outpatient antimicrobial stewardship intervention after discontinuation of audit and feedback. JAMA 2014; 312(23): 2569–2570.

• Quarterly audit and feedback on antibiotic prescribing practices for sinusitis, pharyngitis, and pneumonia with peer comparisons

• One hour of clinician education

Outcomes

• Broad-spectrum antibiotic prescribing rates for sinusitis, pharyngitis, and pneumonia

• Antibiotic prescribing for viral infections

• Cluster randomized controlled trial

Participants

• Pediatric primary care providers

Setting

• 18 pediatric primary care practices in the United States (New Jersey)

• No change in group A Streptococcus pharyngitis prescribing or for viral infections, which were both relatively appropriate at baseline.

• Broad-spectrum prescribing returned to baseline rates once audit-and feedback stopped.

• Benefits were not sustained once the audit-and-feedback ended.

3 behavioral interventions

• Suggested alternatives to antibiotics placed within electronic health records for these diagnoses

• Accountable justification required in medical record for non-recommended antibiotic prescribing

• Peer comparison to top-performing peers

Outcomes

• Rate of antibiotic prescribing for acute respiratory tract infections for which antibiotics are not indicated

• Cluster randomized clinical trial

Participants

• 248 primary care clinicians

Settings

• 47 primary care practices in the United States

o 14753 during baseline

o 16959 during intervention period.

• Antibiotic prescribing decreased from:

o Controls: 24.1% to 13.1%

o Suggested alternatives: 22.1% to 6.1% (p = 0.66 for differences compared with control group)

o Accountable justification: 23.2% to 5.2% (p<0.001)

o Peer comparison: 9.9% to 3.7 (p<0.001).

• Compared with the control group, no intervention showed significant diagnosis shifting.

• Multifaceted clinician education, including communication skills, targeting antibiotic prescribing versus standard care

• Audit and feedback of practice antibiotic dispensing data

Outcomes

• Primary: total number of antibiotics dispensed per 1000 patients by practice

• Secondary: return visits and hospital admissions for respiratory tract infections, and cost

• Randomized controlled trial

ParticipantsParticipants

• General practitioners

Setting

• General practices in United Kingdom (Wales)

• A 4.2% reduction in total antibiotic prescribing was observed in the intervention group compared with controls in one year (p = 0.02).

• No differences in hospital admissions or return visits for respiratory tract infections were observed between the intervention and control groups.

• 5.5% non-significant decreased in antibiotic dispensing cost in intervention group compared with controls.

• Multi-faceted intervention with clinician education, parent education, and audit and feedback on antibiotic prescribing

Outcomes

• Overall oral antibiotic dispensing per person-year of observation for children 3 to <72 months of age

• Community-level cluster-randomized controlled trial

Participants

• Clinicians, parents, and pediatric patients aged 6 years or younger

Setting

• Non-overlapping communities in the United States (Massachusetts)

• Decreasing antibiotic prescribing was seen in all groups, including controls, during study period.

• Intervention led to 4.2% decrease in overall antibiotic prescribing among children 24 to <48 months old and 6.7% among children 48 to <72 months old compared with control communities.

• No difference in antibiotic prescribing for intervention or control communities for children aged 3 to <24 months.

• Clinician and patient education

• Audit and feedback on prescribing practices for upper respiratory infections (URIs) and acute bronchitis

Outcomes

• Primary: Proportion of patients URIs and acute bronchitis with antibiotic prescribed

• Secondary: antibiotic prescribing for antibiotic-appropriate respiratory infections, return ED visits within 2 weeks, and hospital admission within 2 weeks

• Cluster-randomized controlled trial

Participants

• Emergency department (ED) clinicians and patients

Setting

• Hospital EDs, including veterans and non-veterans hospitals in the United States

• Intervention sites had a significant decrease in antibiotic prescribing for URIs and acute bronchitis (-10%; 95% CI -18 to -2%), compared with no change in control sites (0.5% 95% CI -3 to 5%).

• No significant increases in emergency department return visits or patient satisfaction was observed among control or intervention sites.

• Audit and feedback as a letter from England’s Chief Medical Officer sent to the high-prescribing practices defined as the top 20% for their National Health Service (NHS) Local Area Team versus no communication

• Patient education materials versus no materials

Outcomes

• Rate of antibiotics dispensed per 1000 weighted population, controlling for past prescribing

• Pragmatic factorial randomized controlled trial

• Analysis by intention-to-treat

Participants

• General practitioners (GP)

Setting

• GP practices NHS clinics across England

• Letters sent to 3227 GPs

• Intervention group had 126.98 antibiotics dispensed per 1000 population versus and 131.25 antibiotics dispensed per 1000 population in the control group (difference of 3.3%, p<0.001).

• Estimated 73,406 fewer antibiotics dispensed in intervention group.

• No difference in antibiotic prescribing for patient educational materials.