Peer Comparison Feedback for Antimicrobial Stewardship

(PEER AIMS Trial)

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Fahad Razak

Disqualifiers: ICU care, Palliative care, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new method to encourage doctors to use antibiotics more wisely in hospitals. Doctors in the study receive a Peer Comparison Feedback Report, which compares their antibiotic prescribing habits to their peers, along with a toolkit on best practices for antimicrobial use. The goal is to determine if these tools help reduce unnecessary antibiotic use. Physicians working in general medicine who have managed at least 50 hospitalizations qualify for this trial. As an unphased trial, this study offers a unique opportunity to contribute to improving antibiotic use in healthcare settings.

Do I need to stop taking my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications. It focuses on evaluating antimicrobial use by physicians, so it might not directly affect your medication regimen.

What prior data suggests that this peer comparison feedback report is safe?

Previous studies have shown that comparing doctors' antibiotic prescribing habits with their peers is safe. This method involves showing doctors how their antibiotic use compares to others, aiming to reduce unnecessary antibiotic use. Research indicates that this approach can lead to small but meaningful reductions in antibiotic prescriptions without causing harm. No reports of negative effects from this type of feedback exist. Essentially, it is just information shared with doctors, posing no health risks to patients. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Peer Comparison Feedback Report because it introduces a unique approach to improving antimicrobial prescribing practices among healthcare professionals. Unlike traditional methods that rely on guidelines and educational materials, this method uses peer comparison to provide direct feedback on prescribing behavior. By showing how a doctor's prescribing habits compare to their peers, it encourages more responsible use of antimicrobials. This innovative strategy aims to enhance awareness and accountability, potentially reducing unnecessary antibiotic use and combating antibiotic resistance more effectively.

What evidence suggests that peer comparison feedback is effective for reducing antimicrobial use?

This trial will compare the effects of peer comparison feedback on antimicrobial prescribing practices. Research has shown that feedback comparing doctors' antibiotic use to their peers can help reduce unnecessary prescriptions. In one study, doctors who received personalized feedback prescribed shorter courses of antibiotics than those who did not. Another study found that sending feedback letters to primary care doctors led to a significant decrease in overall antibiotic prescriptions. Participants in the intervention group of this trial will receive an electronic peer-comparison feedback report and a knowledge toolkit about antimicrobial use. These reports show doctors how their prescribing habits compare to others, encouraging better choices. Overall, peer feedback effectively promotes responsible antibiotic use. ^{4 6 7 8 9}

Who Is on the Research Team?

Fahad Razak, MD

Principal Investigator

St. Michael's Hospital - Unity Health Toronto

Are You a Good Fit for This Trial?

This trial is for general medicine physicians who prescribe antimicrobials in hospitals. It's designed to see if showing doctors how their prescribing compares with peers, along with a toolkit of best practices, can reduce the amount of drugs used.

Inclusion Criteria

1. Patient-level: All adult inpatients (\>=18 years of age) discharged within the baseline evaluation period and follow up period will be included in a physician report if they match the following criteria: a) Total in-hospital length of stay (LOS) is less than or equal to 14 days; b) and admitted to or discharged from a general medicine or hospitalist ward; c) admitted via the emergency department.

2. Physician-level: Physicians will be included if they have at least 50 hospitalizations attributed to them during the baseline period. Physicians who practice at multiple sites will only be included at the hospital with more encounters.

3. Hospital-level: In total, 29 teaching and community hospitals that provide data to GEMINI, with comprehensive geographic coverage of Ontario, will be included in this trial.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants in the intervention group receive an electronic peer-comparison feedback report and a knowledge toolkit about antimicrobial use

12 months

Follow-up

Participants are monitored for safety and effectiveness after intervention delivery

12 months

What Are the Treatments Tested in This Trial?

Interventions

• Peer Comparison Feedback Report

Trial Overview The intervention being tested is a peer comparison feedback report that shows doctors their antimicrobial prescribing volume compared to others. The study uses data from over 30 Ontario hospitals and includes a best practices toolkit.

How Is the Trial Designed?

Group I: Intervention Group Experimental Treatment 1 Intervention

The intervention group will receive an electronic peer-comparison feedback report on their antimicrobial prescribing practices and a knowledge toolkit about antimicrobial use, bundled as a single intervention.

Group II: Control Group Active Control 1 Intervention

The control group will not receive a peer-comparison feedback report on their antimicrobial prescribing practices, or a knowledge toolkit on antimicrobial use.

Who Is Running the Clinical Trial?

Fahad Razak

Lead Sponsor

Sinai Health System

Collaborator

Trials

26

Recruited

11,900+

Unity Health Toronto

Collaborator

Trials

572

Recruited

470,000+

Canadian Institutes of Health Research (CIHR)

Collaborator

Trials

1,417

Recruited

26,550,000+

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8442778/

Population-Wide Peer Comparison Audit and Feedback to ... In total, 895 (72%) physicians received no feedback; 343 (28%) were enrolled to receive audit and feedback and randomized 1:1 to static or dynamic reports. The ...

2. ichgcp.net ichgcp.net/amp/clinical-trials-registry/NCT07189364

Peer Comparison Feedback Report in Antimicrobial ... The study also aims to understand the qualitative and quantitative impact of peer comparison feedback on antimicrobial prescribing in hospital.

3. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2835846

Spillover From an Intervention on Antibiotic Prescribing for ... The audit-and-feedback approach aims to optimize the effectiveness of antimicrobial stewardship programs. Studies have shown that ...

4. journals.asm.org journals.asm.org/doi/10.1128/spectrum.00017-24

Evaluation of an automated feedback intervention to improve ... The results showed that physicians who received personalized feedback reports prescribed shorter courses of antibiotics compared to controls, ...

5. bmj.com bmj.com/content/385/bmj-2024-079329

Mailed feedback to primary care physicians on antibiotic ... Peer comparison audit and feedback letters significantly reduced overall antibiotic prescribing with no benefit of case-mix adjustment or harms messaging.

6. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/33754632/

Population-Wide Peer Comparison Audit and Feedback to ... Peer comparison audit and feedback is a pragmatic intervention that can generate small relative reductions in the use of antibiotics for prolonged durations.

7. ichgcp.net ichgcp.net/clinical-trials-registry/NCT07189364

Peer Comparison Feedback As An Antimicrobial Prescribing ... The purpose of this study is to evaluate the effect of a peer comparison feedback report, combined with a best practices toolkit, ...

8. qualitysafety.bmj.com qualitysafety.bmj.com/content/34/5/295

Pragmatic randomised trial assessing the impact of peer ... The AF contained personalised and peer-comparison data on first-line antibiotic prescriptions for women with uncomplicated lower UTI and key therapeutic ...

9. academic.oup.com academic.oup.com/cid/article/80/2/253/7917502

Audit and Feedback Interventions for Antibiotic Prescribing in ... This systematic review included 56 randomized trials testing the effect of audit and feedback interventions to improve antibiotic prescribing in primary ca.