Swiss trial finds audit and feedback intervention failed to cut antibiotic prescribing

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A randomized clinical trial conducted in Switzerland found that regular audit and feedback did not reduce antibiotic prescribing among physicians with high prescribing rates, researchers reported today in JAMA Network Open.

To investigate the effect of patient-level claims audit and feedback with peer benchmarking, Swiss investigators enrolled 3,426 primary care physicians and pediatricians who were among the top 75% prescribers of antibiotics. From Jan 1, 2018, through Dec 31, 2019, the participants were randomized 1:1 to undergo quarterly audit and feedback with peer benchmarking and receive evidence-based guidelines for respiratory and urinary tract infections and community-based antibiotic-resistance data (the intervention group) or no intervention (the control group), with 2017 as the baseline year. The primary outcome was the antibiotic prescribing rate per 100 consultations during the second year of the intervention.

The median annual antibiotic prescribing rates per 100 consultations in the year preceding the trial were 8.4 in the intervention group and 8.4 in the control group. A 4.2% relative increase in the antibiotic prescribing rate was observed in the entire cohort during the second year of the intervention compared with 2017, with a median annual antibiotic prescribing rate of 8.2 in the intervention group compared with 8.4 in the control group. Relative to the overall increase, a –0.1% (95% confidence interval CI, –1.2% to 1.0%) lower antibiotic prescribing rate per 100 consultations was found in the intervention group compared with the control group.

No relevant reductions in specific antibiotic prescribing rates in the second year of the intervention were noted between groups except for quinolones (–0.9%; 95% CI, –1.5% to –0.4%). Over the entire trial, antibiotic prescribing rates in the intervention group increased by 0.5% (95% CI, –0.2% to 1.3%) when compared with the control group.

"Whether health system–wide antibiotic stewardship programs with more individually tailored information on the appropriateness of antibiotic prescriptions, eventually combined with individual physician-targeted incentives, might achieve further reductions in antibiotic use should be evaluated in future trials," the investigators wrote.

US cancer screenings slow to recover from initial pandemic dip

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Mary Van Beusekom, MS

As the COVID-19 pandemic took hold in the United States in February and March 2020, observed rates of both lung and breast cancer screenings among Medicare enrollees were 24% and 17%, respectively, below expected rates, rising to -14% and -4% from March 2021 to February 2022, shows a study published late last week in JAMA Network Open.

University of Texas Medical Branch researchers measured observed rates of low-dose computed tomography (LDCT) and mammography from January 2017 to April 2022 and compared them to expected rates for March 2020 to April 2022 (pandemic) using data from January 2016 to February 2020 (prepandemic).

The authors noted that all cancer-screening rates, including mammography, colonoscopy, and LDCT, dropped precipitously early in the pandemic as many healthcare facilities dealt with surges of COVID-19 patients, and patients in general avoided elective visits because of infection fears. As a result, some cancers weren't caught in the early stages, when treatment is often more successful.

Participants in the new study included national yearly samples of more than 3.7 million Medicare fee-for-service enrollees among men and women 55 to 79 years for LDCT and 1.6 million women aged 50 to 74 for mammography.

Targeted actions needed to boost screening

From January 2017 to February 2020, monthly mammography rates were stable, while LDCT rates rose from about 500 per million per month in early 2017 to 1,100 by January 2020. But from March 2020 to February 2020 and March 2021 to February 2022, observed LDCT rates were 24% and 14% below expected rates, and mammography rates were 17% and 4% below expected.

Interference with cancer screening by periodic surges in COVID-19 infections is a continuing problem.

Low income and historically marginalized races were tied to decreased prepandemic cancer screening rates and impaired recovery after the initial surge, which the authors said necessitates more targeted health-related initiatives, including vaccination and initial at-home cancer screening.

"Interference with cancer screening by periodic surges in COVID-19 infections is a continuing problem," the researchers wrote. "Successful interventions to improve screening rates should address pandemic-specific reasons for low screening participation."