Feasibility of a Low-Intensity Intervention to Influence Antibiotic Prescribing Rates Use in Outpatient Settings: A Cluster Randomized Controlled Clinical Trial

Background: Primary care providers (PCPs) may modify their antibiotic prescription practices if aware of their potentially damaging impact.

Methods: We conducted a cluster randomized controlled trial at 12 Veterans Affairs community-based outpatient clinics. PCPs at clinics randomized to the intervention group received quarterly antibiotic use reports with feedback about antibiotics prescribed for acute respiratory infections and adverse event letters alerting about Clostridioides difficile infection or antibiotic-resistant gram-negative bacteria among their patients. The main outcome, antibiotic prescriptions in primary care visits, was compared in the preintervention (April-September 2020), intervention (October 2020 to September 2021), and postintervention periods (September 2021 to September 2022).

Results: Among 52 PCPs at 6 clinics in the intervention group, 66% (33 of 52) and 54% (28 of 52) received ≥1 antibiotic use report and adverse event letter. In the intervention clinics, the proportion of primary care visits with antibiotic prescription during the preintervention, intervention, and postintervention periods was 1.4% (1088 of 77 697), 1.4% (2051 of 147 858), and 1.3% (1692 of 131 530). In the control clinics, this increased from 1.8% (1560 of 87 897) to 2.1% (3707 of 176 825) and 2.1% (3418 of 162 979), respectively, during the intervention and postintervention periods. The rate of visits with antibiotic prescription did not differ in the preintervention period (odds ratio [95% confidence interval], 1.10 [.87-1.39); P = .43) but did during the intervention (1.30 [1.04-1.62]; P = .022) and postintervention periods (1.38 [1.09-1.74]; P = .007). There were no differences in emergency department visits and hospitalizations.

Conclusions: PCPs from clinics assigned to a low-intensity intervention combining comparative feedback with adverse event notifications had lower antibiotic prescription rates.