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Process evaluation of two large randomized controlled trials to understand factors influencing family physicians' use of antibiotic audit and feedback reports.

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اقرأ على الانترنت اقرأ أكثر حفظ في قائمتي
  • معلومة اضافية
    • المصدر:
      Publisher: BioMed Central Country of Publication: England NLM ID: 101258411 Publication Model: Electronic Cited Medium: Internet ISSN: 1748-5908 (Electronic) Linking ISSN: 17485908 NLM ISO Abbreviation: Implement Sci Subsets: MEDLINE
    • بيانات النشر:
      Original Publication: [London] : BioMed Central, 2006-
    • الموضوع:
      Anti-Bacterial Agents*/therapeutic use ; Anti-Bacterial Agents*/administration & dosage ; Practice Patterns, Physicians'*/statistics & numerical data; Humans ; Ontario ; Physicians, Family ; Feedback ; Female ; Male ; Inappropriate Prescribing/prevention & control ; Inappropriate Prescribing/statistics & numerical data ; Primary Health Care ; Qualitative Research ; Medical Audit
    • نبذة مختصرة :
      Background: Unnecessary antibiotic prescriptions in primary care are common and contribute to antimicrobial resistance in the population. Audit and feedback (A&F) on antibiotic prescribing to primary care can improve the appropriateness of antibiotic prescribing, but the optimal approach is uncertain. We performed two pragmatic randomized controlled trials of different approaches to audit and feedback. The trial results showed that A&F was associated with significantly reducing antibiotic prescribing. Still, the effect size was small, and the modifications to the A&F interventions tested in the trials were not associated with any change. Herein, we report a theory-informed qualitative process evaluation to explore potential mechanisms underlying the observed effects.
      Methods: Ontario family physicians in the intervention arms of both trials who were sent A&F letters were invited for one-on-one interviews. Purposive sampling was used to seek variation across interested participants in personal and practice characteristics. Qualitative analysis utilized inductive and deductive techniques informed by the Clinical Performance Feedback Intervention Theory.
      Results: Modifications to the intervention design tested in the trial did not alter prescribing patterns beyond the changes made in response to the A&F overall for various reasons. Change in antibiotic prescribing in response to A&F depended on whether it led to the formation of specific intentions and whether those intentions translated to particular behaviours. Those without intentions to change tended to feel that their unique clinical context was not represented in the A&F. Those with intentions but without specific actions taken tended to express a lack of self-efficacy for avoiding a prescription in contexts with time constraints and/or without an ongoing patient relationship. Many participants noted that compared to overall prescribing, A&F on antibiotic prescription duration was perceived as new information and easily actionable.
      Conclusion: Our findings indicate that contextual factors, including the types of patients and the setting where they are seen, affect how clinicians react to audit and feedback. These results suggest a need to test tailored feedback reports that reflect the context of how, where, and why physicians prescribe antibiotics so that they might be perceived as more personal and more actionable.
      Trial Registration: Clinical Trial registration IDs: NCT04594200, NCT05044052.
      (© 2024. The Author(s).)
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    • Grant Information:
      398514). Canadian Institute of Health Research
    • Contributed Indexing:
      Keywords: Antibiotics; Audit and feedback; Process evaluation
    • Molecular Sequence:
      ClinicalTrials.gov NCT05044052; NCT04594200
    • الرقم المعرف:
      0 (Anti-Bacterial Agents)
    • الموضوع:
      Date Created: 20240916 Date Completed: 20240916 Latest Revision: 20241004
    • الموضوع:
      20241005
    • الرقم المعرف:
      PMC11403851
    • الرقم المعرف:
      10.1186/s13012-024-01393-5
    • الرقم المعرف:
      39285305