Feedback to Improve Rational Strategies of Antibiotic Initiation and Duration in Long Term Care

Overarching Goals The overarching goals of FIRST AID ‐ LTC are two‐fold: 1. Improve rational antibiotic prescribing by physicians to minimize harms among LTC residents. 2. Advance the science of audit‐and‐feedback to improve physician prescribing practices. Specific Aims To improve rational antibiotic prescribing in LTC: 1. by decreasing unnecessary initiation of antibiotic treatments among Ontario LTC residents, as well as the variability in initiation rates across LTC prescribers. 2. by decreasing unnecessary prolonged duration of antibiotic treatments among Ontario LTC residents, as well as the variability in prolonged duration treatment use across LTC prescribers. To advance audit‐and‐feedback implementation science: 1. by evaluating whether a dynamic audit‐and‐feedback report highlighting antibiotic prescribing can lead to greater reductions in antibiotic use, than a static paginated report Anticipated Contributions to Health‐Related Knowledge Although the literature is inundated with trials examining the impact of audit‐and‐feedback compared to usual care, there is a need for studies to improve audit‐and‐feedback delivery. FIRST AID‐LTC will test optimal delivery and peer comparison techniques for audit‐and‐feedback. The knowledge learned can be extrapolated to antibiotic interventions in LTC in other provinces across Canada, as well more broadly to inappropriate medication prescribing practices in LTC. Anticipated Contributions to Health Care, Health Systems and Health Outcomes FIRST AID‐LTC will lead to immediate reductions in excess antibiotic use in Ontario LTC facilities, which in turn should result in substantial reductions in direct drug costs, as well as downstream complications of allergy, organ toxicity, C. difficile infections and antimicrobial resistance. With easy transferability to other Canadian provinces, the improvements in cost‐savings and patient outcomes could be massive in scope.