Spillover From an Intervention on Antibiotic Prescribing for Family Physicians: A Post Hoc Secondary Analysis of a Randomized Clinical Trial
Abstract
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…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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