Grant: Project Grant

Antimicrobial resistance occurs when microorganisms become resistant to antimicrobial medicines. This makes it difficult to treat infections and increases transmission, severe illness, and death. In Canada, an estimated 14,000 deaths were the result of antimicrobial resistant bacterial infections in 2018. By 2050, the number of annual deaths from antimicrobial resistant infections will exceed cancer. Antimicrobial resistance is a rapidly growing public health emergency driven by overuse of antimicrobial medicines. Our team has shown that hospital physicians use antimicrobial medicine at very different rates from one another, but that patients of low-prescribing physicians do not have worse in-hospital outcomes. This builds on evidence that it is safe to reduce antimicrobial prescribing in hospital. A previous Ontario study demonstrated that a single audit and feedback report reduced outpatient antibiotic prescriptions, but it is unknown whether these results generalize to hospitals where antimicrobial use is more common, patients are sicker, and the risk of undertreating infections is more serious. Electronic health records present new opportunities to use detailed medication data for audit and feedback. We propose a randomized trial to evaluate the effect of an audit and feedback report on the volume of antimicrobial use by general medicine physicians. We will randomize physicians to a peer-comparison report with an embedded quality improvement toolkit, or no report. We will compare the number of days that patients were prescribed antimicrobial medicines. Our study design will leverage robust data from GEMINI, a hospital research collaborative that collects administrative and clinical data from 30 Ontario hospitals, representing ~60% of all adult medical/ICU beds in Ontario. We are in a position to rapidly integrate our findings into established peer-comparison feedback reports that reach physicians responsible for >60% of general medicine care in Ontario.