Implementing an audit and feedback cycle to improve adherence to the Choosing Wisely Canada recommendations: clustered randomized trail

Alexander Singer; Leanne Kosowan; Elissa M Abrams; Alan Katz; Lisa Lix; Katrina Leong; Allison Paige

doi:10.1186/s12875-022-01912-7

Implementing an audit and feedback cycle to improve adherence to the Choosing Wisely Canada recommendations: clustered randomized trail

BMC Prim Care. 2022 Nov 26;23(1):302. doi: 10.1186/s12875-022-01912-7.

Authors

Alexander Singer¹, Leanne Kosowan², Elissa M Abrams^{3

4}, Alan Katz^{5

6}, Lisa Lix⁷, Katrina Leong², Allison Paige²

Affiliations

¹ Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, Winnipeg, MB, R3E0W2, Canada. alexander.singer@umanitoba.ca.
² Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, Winnipeg, MB, R3E0W2, Canada.
³ Department of Pediatrics, Section of Allergy and Clinical Immunology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
⁴ Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, BC, Canada.
⁵ Departments of Community Health Science & Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
⁶ Manitoba Centre for Health Policy, Winnipeg, MB, Canada.
⁷ Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.

Abstract

Background: Audit and Feedback (A&F), a strategy aimed at promoting modified practice through performance feedback, is a method to change provider behaviour and reduce unnecessary medical services. This study aims to assess the use of A&F to reduce antibiotic prescribing for viral infections and antipsychotic prescribing to patients with dementia.

Methods: Clustered randomized trial of 239 primary care providers in Manitoba, Canada, participating in the Manitoba Primary Care Research Network. Forty-six practices were randomly assigned to one of three groups: control group, intervention 1 (recommendations summary), intervention 2 (recommendations summary and personalized feedback). We assessed prescribing rates prior to the intervention (2014/15), during and immediately after the intervention (2016/17) and following the intervention (2018/19). Physician characteristics were assessed.

Results: Between 2014/15-2016/17, 91.6% of providers in intervention group 1 and 95.9% of providers in intervention group 2 reduced their antibiotic and antipsychotic prescribing rate by ≥ 1 compared to the control group (77.6%) (p-value 0.0073). This reduction was maintained into 2018/19 at 91.4%. On multivariate regression alternatively funded providers had 2.4 × higher odds of reducing their antibiotic prescribing rate compared to fee-for-service providers. In quantile regression of providers with a reduction in antibiotic prescribing, alternatively funded (e.g. salaried or locum) providers compared to fee-for-service providers were significant at the 80^th quantile.

Conclusions: Both A&F and recommendation summaries sent to providers by a trusted source reduced unnecessary prescriptions. Our findings support further scale up of efforts to engage with primary care practices to improve care with A&F.

Trial registration: ClinicalTrials.gov NCT05385445, retrospectively registered, 23/05/2022.

Keywords: Access and evaluation; Choosing wisely; Health care quality; Health services research; Primary health care; Randomized controlled trial.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Anti-Bacterial Agents / therapeutic use
Antipsychotic Agents*
Feedback
Humans
Physicians, Family
Practice Patterns, Physicians'*

Substances

Antipsychotic Agents
Anti-Bacterial Agents

Associated data

ClinicalTrials.gov/NCT05385445