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Tracking and Reporting

For Healthcare Professionals

Monitor antibiotic prescribing practices and offer regular feedback to clinicians, or have clinicians assess their own antibiotic prescribing practices themselves.

Audit and Feedback
Reference Interventions and Outcomes Methods, Participants, and Settings Results Conclusions
Gerber JS, et al. Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians: A randomized trial. JAMA 2013. 309(22): 2345–52.

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.

Intervention

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

 

Methods

Cluster randomized controlled trial

Participants

Pediatric primary care providers

Setting

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

Intervention group showed a reduction in broad-spectrum antibiotic prescribing compared with controls with6.7% difference in differences.

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.

Audit and feedback with peer comparisons and with clinician education led to decreases in non-recommended broad-spectrum antibiotic prescribing.

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

Meeker et al. Effect of behavioral interventions on inappropriate antibiotic prescribing among primary care practices: A randomized clinical trial. JAMA 2016;315(6):562–70. Interventions

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

Methods

Cluster randomized clinical trial

Participants

248 primary care clinicians

Settings

47 primary care practices in the United States

31,712 visits for acute respiratory tract infections for which antibiotics are not indicated:
  • 14753 during baseline
  • 16959 during intervention period.

Antibiotic prescribing decreased from:

  • Controls: 24.1% to 13.1%
  • Suggested alternatives: 22.1% to 6.1% (p = 0.66 for differences compared with control group)
  • Accountable justification: 23.2% to 5.2% (p<0.001)
  • Peer comparison: 9.9% to 3.7 (p<0.001).

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

Accountable justification and peer comparison interventions reduced antibiotic prescribing for acute respiratory tract infections for which antibiotics are not indicated
Butler CC, et al. Effectiveness of multifaceted educational program to reduce antibiotic dispensing in primary care: Practice based randomized controlled trial. BMJ 2012. 344:d8173. Intervention

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

Methods

Randomized controlled trial

ParticipantsParticipants

General practitioners

Setting

General practices in United Kingdom (Wales)

68 practices serving 480,000 patients

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.

A clinician educational intervention led to reductions in antibiotic dispensing with no changes in hospital admissions, return visits, or costs.
Finkelstein JA, et al. Impact of a 16-community trial to promote judicious antibiotic use in Massachusetts. Pediatrics 2008. 121(1):e15–23. Intervention

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

 

Methods

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)

16 communities with 223,135 person-years observed

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.

A large community intervention modestly decreased antibiotic use.

 

Metlay JP, et al. Cluster-randomized trial to improve antibiotic use for adults with acute respiratory infections treated in emergency departments. Ann Emerg Med 2007. 50(3):221–30. Intervention

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

 

Methods

Cluster-randomized controlled trial

Participants

Emergency department (ED) clinicians and patients

Setting

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

16 EDs with 5,665 visits by adults for acute respiratory infections

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.

Multifaceted education interventions combined with audit and feedback can decrease antibiotic prescribing for ED patients with URIs and acute bronchitis.
Hallsworth M, et al. Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomized controlled trial. The Lancet 2016. 387:1743–52

 

Interventions

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

 

Methods

Pragmatic factorial randomized controlled trial

Analysis by intention-to-treat

Participants

General practitioners (GP)

Setting

GP practices NHS clinics across England

 

1581 practices

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.

Audit and feedback from an important figure (e.g., England’s Chief Medical Officer) reduced antibiotic prescribing at the national level.

 

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