Status:
COMPLETED
Feedback to Improve Rational Strategies of Antibiotic Initiation and Duration in Long Term Care
Lead Sponsor:
Institute for Clinical Evaluative Sciences
Collaborating Sponsors:
Canadian Institutes of Health Research (CIHR)
Ontario Agency for Health Protection and Promotion
Conditions:
Antibiotic Initiation
Antibiotic Duration
Eligibility:
All Genders
Phase:
NA
Brief Summary
There is a high rate of inappropriate antibiotic use in long-term care (LTC) facilities, with both unnecessary initiation and prolongation of treatments. Although there are challenges to rational anti...
Detailed Description
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 aud...
Eligibility Criteria
Inclusion
- To Identify an LTC Resident
- An individual having a minimum of 2 records on separate days within the quarter meeting any combination of the following criteria:
- a record for a non-emergency long-term care inpatient services OR
- an Ontario Drug Benefits record administered in long-term care
- Index date = The analysis will be anchored on the most recent of either of the records above within a given quarter or their date of death (whichever date is earliest)
Exclusion
- Non-Ontario resident at index date
- Invalid age (age\<19 or age\>115) at index date
- Missing or invalid sex or date of birth at index date
- Death date is \>7 days before index date
- If the individual does not live in a nursing home or home for the aged
- Cannot be linked to a Most Responsible Physician (MRP) (see methodology below)
- To Identify the Most Responsible Physician (MRP) Using Virtual Rostering
- For each patient in the above resident cohort, the study team will retrieve all records from health care providers in the 6 month period preceding the index date (180 days), keeping only records from physicians who have a specialty of 1) general practice, 2) community medicine or 3) geriatrics.
- Steps for MRP assignment:
- Step 1) The study team will first select physicians with the highest count of records for the monthly management of a nursing home or home for the aged. This is completed for as many residents as possible.
- Step 2) If there were no monthly management fee records as described above then the physician with highest count of non-emergency long-term care inpatient services records for each patient will be selected. This step is only applied to residents who could not be matched to a physician by Step 1. \*\*Physician must have seen the patient one or more times in 90 days prior to and including index date to be considered MRP. This criteria is applied to ensure the physician has seen the resident within the reporting quarter.
- Step 3) Some patients will virtually roster to physicians in Enrollment groups, some will virtually roster to physicians that are not in a group. For these, the study team will recode enrollment program type to 'NOR' (not otherwise rostered) - these are likely fee for service physicians.
Key Trial Info
Start Date :
May 15 2017
Trial Type :
INTERVENTIONAL
Allocation :
ACTUAL
End Date :
March 31 2021
Estimated Enrollment :
356 Patients enrolled
Trial Details
Trial ID
NCT03807466
Start Date
May 15 2017
End Date
March 31 2021
Last Update
August 25 2021
Active Locations (1)
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1
ICES
Toronto, Ontario, Canada, M4N 3M5