Improving Antibiotic Use for ARIs in Urgent Care Clinics

Daniel Livorsi

Status: Active, not recruiting

Conditions: Antibacterial Agents; Ambulatory Care

Treatments: Behavioral: Feedback on RTD metric

Study type: Interventional

Funder types: Other

Identifiers

NCT06144242

202308456

Details and patient eligibility

About

Many clinicians prescribe antibiotics for patients with acute respiratory infections even when antibiotics will not benefit the patient because the infection is due to a virus. To discourage this type of unnecessary antibiotic use, the investigators will assess whether it is helpful to give clinicians feedback on how often they prescribe antibiotics for respiratory infections in comparison to their peers. The investigators will perform this study across Urgent Care and QuickCare clinics within a single healthcare system.

Full description

The investigators have used an established HEDIS (Healthcare Effectiveness Data and Information Set) metric to evaluate Urgent Care and QuickCare clinicians on their antibiotic use for respiratory tract diagnoses (RTDs). This RTD metric excludes visits that are more complicated, based on well-defined criteria. Based on our baseline assessment (2018-2022), the investigators estimate that most clinicians in this setting are frequently prescribing unnecessary antibiotics.

The investigators will perform a randomized controlled trial to assess whether providing individualized feedback to clinicians on the RTD metric can safely reduce antibiotic use for qualifying respiratory tract visits across Urgent and QuickCare settings within a single integrated healthcare system. Clinicians who do not opt-out of the trial will be randomized to either receive feedback or not receive feedback on this RTD metric. The trial will last for 18 months. The primary outcome of effectiveness will be the frequency of antibiotic-prescribing for RTD visits. Secondary outcomes include total antibiotic use (regardless of diagnosis), changes in the use of diagnostic codes, 30-day rates of follow-up visits and hospital admissions. The RE-AIM framework will be used to guide additional study evaluation.

Enrollment: 90 estimated patients

Sex: All

Ages: 21 to 99 years old

Volunteers: Accepts Healthy Volunteers

Inclusion and exclusion criteria

Any clinician who works in Urgent Care or QuickCare clinics within our healthcare system.

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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90 participants in 2 patient groups

Feedback on RTD metric

Experimental group

Description:

An e-mail will be sent to the clinicians in the experimental arm every two months describing their performance on the RTD metric and making a comparison to how their peers have performed. The e-mail will also direct clinicians to visit a dashboard to review their practice in greater depth.

Treatment:

Behavioral: Feedback on RTD metric

No feedback on RTD metric

No Intervention group

Description:

Any clinician assigned to the control arm will not receive the above-mentioned e-mails.