In a Swiss study, primary care physicians in Switzerland with medium-to-high antibiotic prescription rates did not change their prescribing patterns in response to a quarterly personalized antibiotic prescribing audit and feedback with peer benchmarking.
In 2018-19, primary care physicians and pediatricians in single or small practices among the top 75% prescribers of antibiotics were identified using patient-level claims data from 3 health insurers serving about half of insurees in Switzerland. The 3,426 prescribers were randomized to undergo quarterly antibiotic prescribing audits and feedback with peer benchmarking or no intervention for 2 years. The intervention group also received evidence-based guidelines for respiratory and urinary tract infections and community antibiotic resistance information. With 2017 serving as a baseline, claims data were analyzed for a primary outcome of antibiotic prescribing rate per 100 consultations during the second year of the intervention.
“A total of 3,426 physicians were randomized to the intervention (n = 1,713) and control groups (n = 1,713) serving 629,825 and 622,344 patients, respectively, with a total of 4,790,525 consultations in the baseline year of 2017,” the authors report. “In the entire cohort, a 4.2% (95% CI, 3.9%-4.6%) relative increase in the antibiotic prescribing rate was noted during the second year of the intervention compared with 2017. In the intervention group, the median annual antibiotic prescribing rate per 100 consultations was 8.2 (IQR, 6.1-11.4) in the second year of the intervention and was 8.4 (IQR, 6.0-11.8) in the control group. Relative to the overall increase, a –0.1% (95% CI, –1.2% to 1.0%) lower antibiotic prescribing rate per 100 consultations was found in the intervention group compared with the control group. No relevant reductions in specific antibiotic prescribing rates were noted between groups except for quinolones in the second year of the intervention (–0.9% [95% CI, –1.5% to –0.4%]).”
Visual abstract available on the JAMA Internal Medicine website.