Education vs Clinician Feedback on Antibiotic Prescriptions for Acute Respiratory Infections in Telemedicine: a Randomiz
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Boston Medical Center, Boston, MA, USA; 2Doctor On Demand, Professional Corporation, San Francisco, CA, USA; 3Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, George Washington Milken Institute of Public Health, Washington, DC, USA; 4 Stanford University School of Medicine, Stanford, CA, USA; 5Division of Infectious Diseases, Children’s National Hospital, Washington, DC, USA; 6 George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
BACKGROUND: Antibiotics prescribed for acute respiratory tract infections in the telemedicine setting are often unwarranted. OBJECTIVE: We hypothesized that education plus individualized feedback, compared with education alone, would significantly reduce antibiotic prescription rates for upper respiratory infections, bronchitis, sinusitis, and pharyngitis in a telemedicine setting. DESIGN: Two-arm, parallel-group randomized controlled trial conducted at a telemedicine practice from January 1, 2018, to November 30, 2018. PARTICIPANTS: Clinicians employed at the practice on or after January 1, 2017 (n = 45). INTERVENTIONS: The control group received education (treatment guideline presentation and online course) in April 2018. The intervention group received education plus individualized feedback via an online dashboard with monthly rates of personal and practice-wide antibiotic prescription rates starting May 2018. MAIN MEASURES: Antibiotic prescription for any visit with at least one target condition: upper respiratory tract infection, bronchitis, sinusitis, and pharyngitis. KEY RESULTS: Baseline antibiotic prescription rates in control and intervention groups across conditions were as follows: upper respiratory infection (URI): 626/3410 (18.4%), 413/2752 (15.0%), bronchitis: 689/1471 (46.8%), 742/1162 (64.0%), sinusitis: 5154/6131 (84.1%), 4250/4876 (87.2%), pharyngitis: 2308/2838 (81.3%), 1593/2126 (74.9%). Antibiotic prescriptions for all conditions decreased in the post-intervention period compared with those in the pre-intervention period, for both control and intervention groups. Reduction of antibiotic prescriptions for URI and bronchitis was greater for the group receiving education plus individualized feedback compared with that for the group receiving Prior presentations: IDWeek in San Francisco, CA on Oct 4 2018. Annual International Pediatric Antimicrobial Stewardship Conference in St. Louis, MO, on May 31, 2019. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-06134-0) contains supplementary material, which is available to authorized users. Received August 28, 2019 Accepted August 11, 2020
education alone (interaction term ratio 0.60, 95% CI 0.47 to 0.77 for URI; and interaction term ratio 0.42, 95% CI 0.32 to 0.55 for bronchitis), but not sinusitis and pharyngitis. CONCLUSION: Education plus individualized feedback in a telemedicine practice significantly decreased antibiotic prescription rates for upper respiratory tract infections and bronch
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