PARTI: Antimicrobial Stewardship for Primary Care Pediatricians

Sponsor

Children's Hospital of Philadelphia (Other)

Overall Status

Completed

CT.gov ID

NCT01806103

Collaborator

(none)

170

Enrollment

Location

Arms

Duration (Months)

5.7

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

The purpose of the study is to determine if physician education coupled with audit and feedback of antibiotic prescribing can improve antibiotic prescribing by primary care clinicians.

Condition or Disease	Intervention/Treatment	Phase
Acute Sinusitis Streptococcal Pharyngitis Pneumonia Viral Infection	Behavioral: Antimicrobial Stewardship Bundle	N/A

Detailed Description

Using a large, diverse pediatric primary care network sharing a comprehensive electronic health record (EHR), a cluster-randomized trial will be performed to determine the effectiveness of an outpatient antimicrobial stewardship bundle, including treatment guidelines coupled with audit and feedback of physician prescribing, to curb inappropriate antibiotic prescribing for respiratory tract infections.

Aim 1: To determine the impact of an outpatient antimicrobial stewardship bundle within a pediatric primary care network on antibiotic prescribing for conditions for which antibiotics are not indicated.

Hypothesis: Antimicrobial stewardship will decrease rates of antibiotic prescribing for conditions for which antibiotics are not indicated.

Aim 2: To determine the impact of an outpatient antimicrobial stewardship bundle within a pediatric primary care network on broad-spectrum antibiotic prescribing for conditions for which narrow-spectrum antibiotics are indicated.

Hypothesis: Antimicrobial stewardship will decrease the rate of broad-spectrum antibiotic prescribing for conditions for which narrow-spectrum antibiotics are indicated.

Study Design

Study Type:

Interventional

Actual Enrollment :

170 participants

Allocation:

Randomized

Intervention Model:

Single Group Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

Reducing Inappropriate Prescribing of Antibiotics by Primary Care Clinicians

Study Start Date :

Jun 1, 2010

Actual Primary Completion Date :

Jun 1, 2011

Actual Study Completion Date :

Dec 1, 2012

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Antimicrobial Stewardship Bundle An intervention "bundle" to reduce outpatient antibiotic use in children will include education, creation of and access to guidelines, and audit of and feedback on individual prescribing within the context of achievable benchmarks.	Behavioral: Antimicrobial Stewardship Bundle Guidelines, Education, Audit and Feedback
No Intervention: Control Control sites will be within strata to maintain balance of treatment arm within strata

Arm

Intervention/Treatment

Experimental: Antimicrobial Stewardship Bundle

An intervention "bundle" to reduce outpatient antibiotic use in children will include education, creation of and access to guidelines, and audit of and feedback on individual prescribing within the context of achievable benchmarks.

Behavioral: Antimicrobial Stewardship Bundle

Guidelines, Education, Audit and Feedback

No Intervention: Control

Control sites will be within strata to maintain balance of treatment arm within strata

Outcome Measures

Primary Outcome Measures

Reduction in the rate of broad-spectrum antibiotic prescribing for targeted conditions for which narrow-spectrum antibiotic therapy is indicated [from 20 months prior through 13 months post intervention]
The primary outcome measure seeks to determine if the incorporation of treatment guidelines coupled with audit and feedback of physician prescribing can reduce the the rate of antibiotic prescribing for targeted conditions for which antibiotic therapy is not indicated.

Secondary Outcome Measures

The rate of antibiotic prescribing for targeted conditions for which antibiotic therapy is not indicated [from 20 months prior through 13 months post intervention]
The secondary outcome measure seeks to determine the rate of broad-spectrum antibiotic prescribing for targeted conditions for which narrow-spectrum antibiotic therapy is indicated. Thus, two classes of diagnoses will be collected: 1) respiratory tract infections for which no antibiotics are indicated, represented by a group codes indicating common infections with presumed viral etiology and 2) bacterial respiratory tract infections for which narrow spectrum antibiotics are indicated

Eligibility Criteria

Criteria

Ages Eligible for Study:

N/A and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Primary care pediatric practices within the CHOP Care Network

Exclusion Criteria:

Academic primary care pediatric practices within the CHOP Care Network
Providers entering a practice after the start of the intervention
Providers with less than 25 antibiotic prescriptions in the 6 months prior to the start of the intervention