Grant: Project Grant

Antibiotics are among the most common medications prescribed to long term care residents, and 1/4-3/4 of these treatments are inappropriate or unnecessary, thereby exposing this vulnerable population to avoidable allergic reactions, drug side effects, Clostridium difficile infection, and antibiotic resistant bacteria. Antibiotic use varies widely across long term care facilities, and residents of high antibiotic use facilities experience more of these antibiotic-related harms. The variation in antibiotic use across facilities is driven more by prescriber habits and tendencies, than by the types of residents they treat. Some prescribers have a tendency to start antibiotic treatments in a higher percentage of their patients; some have a tendency to use overly prolonged treatments. Therefore, peer-comparison audit-and-feedback has the potential to lead to major improvements in the quality of antibiotic prescribing in long term care. This technique involves providing feedback reports to prescribers which show them how they are performing in comparison to their colleagues. There is extensive evidence that this intervention can improve the quality of medication prescribing, but more research is needed to determine the best ways to deliver the feedback. The Feedback to Improve Rational STrategies of Antibiotic Initiation and Duration in Long Term Care (FIRST AID - LTC) study will randomly assign Ontario long term care prescribers to different feedback strategies regarding their tendencies to start and prolong antibiotics. In doing so, FIRST AID-LTC will advance the science of audit-and-feedback, while providing immediate reductions in unnecessary antibiotic treatments and unnecessarily prolonged antibiotic treatments. The end result will be improved health outcomes for long-term care patients, with reductions in allergies, side effects, Clostridium difficile infections, antibiotic resistant organisms and hospital admissions.