Exemplar Trial Overview - Schwartz, et al. (13-min video & 18-slide presentation)

• Summary: Dr. Kevin Schwartz overviews a pragmatic randomized controlled trial of mailed antibiotic audit and feedback reports to primary care physicians with an embedded 2x2 factorial experiment in Ontario, Canada. With the goal of directly informing policy and decision making, the research team evaluated the effectiveness of an audit and feedback intervention under usual conditions across the province, where eligible physicians and outcomes were identified through existing routinely collected administrative data.

Schwartz KL, et al. Mailed feedback to primary care physicians on antibiotic prescribing for patients aged 65 years and older: pragmatic, factorial randomised controlled trial. BMJ. 2024 Jun 5;385:e079329. Erratum in: BMJ. 2024 Jun 12;385:q1261. (11-page paper)

• Summary: Publication in the BMJ describing a pragmatic trial with the primary objective of evaluating whether providing family physicians with feedback on their antibiotic prescribing, using routinely collected data, compared with their peers, reduced antibiotic use. The secondary objectives were to test whether further incremental reductions could be made in antibiotic prescribing by providing two more forms of feedback.

Exemplar Trial - Schwartz, et al. (12-min video & 15-slide presentation)

• Summary: Dr. Kevin Schwartz breaks down the pragmatic factorial randomized trial (of antibiotic audit and feedback reports) across sections of the curriculum wheel.

Schwartz KL, et al. Web Appendix (BMJ. 2024 Jun 5;385:e079329) - Examples of feedback letters (the intervention) sent to primary care physicians regarding their antibiotic prescribing. (56-page document)

• Summary: Supplemental material showing examples of antibiotic audit and feedback reports sent to primary care physicians (the intervention). These letters show the personal antibiotic prescribing data of the primary care physician, describe harms of antibiotics, and provide guidance, resources, and communication tips to physicians (to help in reducing their antibiotic prescribing). Additional questions are answered, e.g., “Where did we get these data?” “How did we define your peers for comparison?” “What is the evidence for shorter antibiotic durations?”

Shuldiner J,  et al. Optimizing responsiveness to feedback about antibiotic prescribing in primary care: protocol for two interrelated randomized implementation trials with embedded process evaluations. Implement Sci. 2022 Feb 14;17(1):17. (17-page paper)

• Summary: This protocol describes the rationale and methodology of two related pragmatic trials (one of which is the exemplar trial described herein) testing variations of theory-informed components of an audit and feedback intervention to determine how to optimize such interventions for antibiotic prescribing in primary care.

Shuldiner J, et al. Process evaluation of two large randomized controlled trials to understand factors influencing family physicians' use of antibiotic audit and feedback reports. Implement Sci. 2024 Sep 16;19(1):65. (15-page paper)

• Summary: This paper describes a theory-informed qualitative process evaluation to explore potential mechanisms underlying the small but significant effect sizes found in both this exemplar trial (assessing mailed antibiotic audit and feedback reports) and a separate, but related pragmatic trial (using a different approach to audit and feedback).

Schwartz KL, et al. Do Fair Comparisons or Harms Data Increase Responsiveness to Feedback About Antibiotic Prescribing: 2x2 Factorial Trial. ClinicalTrials.gov identifier: NCT04594200. Updated 2023-01-05. (8-section website)

• Summary: Public registration of the trial (i.e., study overview, contacts and locations, study plan, collaborators and investigators, publications, study record dates).