Spillover From an Intervention on Antibiotic Prescribing for Family Physicians
Notice bibliographique
Résumé
Importance: Antibiotic audit and feedback is effective at reducing antibiotic prescribing in primary care. Objective: To evaluate the spillover of an audit-and-feedback intervention originally targeted at patients aged 65 years or older on a broader population of all age groups. Design, Setting, and Participants: This is a post hoc secondary analysis of a randomized clinical trial that was conducted among primary care physicians in Ontario, Canada. Physicians were randomized in a 4:1 allocation, with a peer comparison feedback letter sent in January 2022. Physicians in the control group received no letter. The randomized clinical trial was conducted from January 2021 to December 2022, and this analysis was performed from March to June 2024. Exposure: A mailed antibiotic prescribing feedback letter, with peer comparison. Main Outcomes and Measures: The primary outcome was the total number of antibiotic prescriptions by physicians at 12 months after the intervention for patients of all ages. This analysis was conducted utilizing a different administrative data source than the original trial; this source contained antibiotic prescription counts for all patient age groups. Data were analyzed with Poisson regression models, adjusted for baseline prescribing and stratified by patient age and sex. Results: Overall, 4964 of 5097 randomized physicians (97.4%) were included in this analysis. There were 3967 (74.5%) in the intervention group and 997 (25.5%) in the control group; 2766 physicians (55.7%) were male, and 2549 (51.3%) had been in practice for 25 years or more. The intervention group showed a reduction in antibiotic prescriptions at 12 months after intervention compared with the control group (adjusted rate ratio [aRR], 0.93; 95% CI, 0.93-0.94). Significant reductions were seen across all age and sex groups and for antibiotics typically used for respiratory infections. Additionally, the proportion of prescriptions exceeding 7 days decreased significantly in the intervention group (aRR, 0.82; 95% CI, 0.82-0.83). Conclusions and Relevance: In this post hoc secondary analysis of a randomized clinical trial of peer comparison antibiotic audit and feedback for physicians with data from patients aged 65 and older, the intervention group had a reduction in antibiotic prescriptions across all patient ages. These findings suggest that routinely collected administrative data can be effectively used for implementing and evaluating antibiotic audit and feedback, even when limited to older patients. Trial Registration: ClinicalTrials.gov Identifier: NCT04594200.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».