Evaluation of an automated feedback intervention to improve antimicrobial prescribing among primary care physicians (OPEN Stewardship): protocol for an interrupted time-series and usability analysis in Ontario, Canada and Southern Israel

• Published in: BMJ open Vol. 11; no. 1; p. e039810
• Main Authors: Soucy, Jean-Paul R, Low, Marcelo, Acharya, Kamal Raj, Ellen, Moriah, Hulth, Anette, Löfmark, Sonja, Garber, Gary E, Watson, William, Moran-Gilad, Jacob, Fisman, David N, MacFadden, Derek R
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 13-01-2021; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Protocol
• Subjects: Ambulatory care; Anti-Bacterial Agents - therapeutic use; Anti-Infective Agents - therapeutic use; Antimicrobial agents; Automation; Drug resistance; Epidemiology; Family physicians; Feedback; Hospitals; Humans; infectious diseases; Intervention; Israel; Ontario; Physicians; Physicians, Primary Care; Practice Patterns, Physicians; Primary care; Public Health; Time series; Usability; Ontario; Israel; Ontario Canada; Canada; United States > US; epidemiology; primary care; public health; infectious diseases
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-039810

IntroductionAntimicrobial resistance undermines our ability to treat bacterial infections, leading to longer hospital stays, increased morbidity and mortality, and a mounting burden to the healthcare system. Antimicrobial stewardship is increasingly important to safeguard the efficacy of existing drugs, as few new drugs are in the developmental pipeline. While significant progress has been made with respect to stewardship in hospitals, relatively little progress has been made in the primary care setting, where the majority of antimicrobials are prescribed. OPEN Stewardship is an international collaboration to develop an automated feedback platform to improve responsible antimicrobial prescribing among primary care physicians and capable of being deployed across heterogeneous healthcare settings. We describe the protocol for an evaluation of this automated feedback intervention with two main objectives: assessing changes in antimicrobial prescribing among participating physicians and determining the usability and usefulness of the reports.Methods and analysisA non-randomised evaluation of the automated feedback intervention (OPEN Stewardship) will be conducted among approximately 150 primary care physicians recruited from Ontario, Canada and Southern Israel, based on a series of targeted stewardship messages sent using the platform. Using a controlled interrupted time-series analysis and multilevel negative binomial modelling, we will compare the antimicrobial prescribing rates of participants before and after the intervention, and also to the prescribing rates of non-participants (from the same healthcare network) during the same period. We will examine outcomes targeted by the stewardship messages, including prescribing for antimicrobials with duration longer than 7 days and prescribing for indications where antimicrobials are typically unnecessary. Participants will also complete a series of surveys to determine the usability and usefulness of the stewardship reports.Ethics and disseminationAll sites have obtained ethics committee approval to recruit providers and access anonymised prescribing data. Dissemination will occur through open-access publication, stakeholder networks and national/international meetings.