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.
• Quarterly audit and feedback on antibiotic prescribing practices for sinusitis, pharyngitis, and pneumonia with peer comparisons
• One hour of clinician education
• Broad-spectrum antibiotic prescribing rates for sinusitis, pharyngitis, and pneumonia
• Antibiotic prescribing for viral infections
• Cluster randomized controlled trial
• Pediatric primary care providers
• 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
• Rate of antibiotic prescribing for acute respiratory tract infections for which antibiotics are not indicated
• Cluster randomized clinical trial
• 248 primary care clinicians
• 47 primary care practices in the United States
|• 31,712 visits for acute respiratory tract infections for which antibiotics are not indicated:
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.
|• 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
• 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
• General practitioners
• 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
• Overall oral antibiotic dispensing per person-year of observation for children 3 to <72 months of age
• Community-level cluster-randomized controlled trial
• Clinicians, parents, and pediatric patients aged 6 years or younger
• 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
• 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
• Emergency department (ED) clinicians and patients
• 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
• 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
• Rate of antibiotics dispensed per 1000 weighted population, controlling for past prescribing
• Pragmatic factorial randomized controlled trial
• Analysis by intention-to-treat
• General practitioners (GP)
• 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.
- Page last reviewed: April 17, 2015
- Page last updated: May 12, 2017
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