Are you interested in receiving feedback electronically?

You may be eligible for Ontario Health’s MyPractice Primary Care Plus (with Screening Activity Report data). This is a confidential report that provides family physicians with an informative perspective on their individual practice and patients. The report is available on the eReport platform through ONE ID registration. To learn more, visit https://www.cancercareontario.ca/en/primary-care-reports

Where did we get these data?

These data are meant for your own quality improvement. We cannot share it with anyone except you. The data for this report were derived from the Ontario Drug Benefit (ODB) database housed at ICES (formerly, the Institute for Clinical Evaluative Sciences). The ODB database captures >99% of dispensed prescriptions, but is limited to patients ≥ 65 years of age; however, antibiotic prescribing in patients ≥ 65 is highly correlated with overall antibiotic use for all age groups among Ontario family physicians. We have also provided data on peer comparison to give context to the findings. Physicians were excluded from the intervention if they saw less than 100 patients ≥ 65 years of age or prescribed less than 10 antibiotics to patients ≥ 65 years of age in the most recent year or two of the three years of data.

How did we define antibiotic prescribing appropriateness?

Some physicians received data on antibiotic prescribing appropriateness. Antibiotic prescriptions that were most likely unnecessary was defined as an antibiotic prescription dispensed to a patient within 3 days after one of the diagnostic codes in the table below for a respiratory infection that rarely requires antibiotics, and no other diagnostic code used in that 3-day period. This definition has been previously used to study antibiotic prescribing appropriateness in Ontario, and based on the best available evidence for appropriate antibiotic prescribing. Approximately 20% of patients with acute sinusitis will benefit from antibiotics with criteria found in the Cold Standard toolkit (http://bit.ly/abx-pc).

How did we define your peers for comparison?

Total antibiotic prescribing was defined as the total number of oral antibiotic prescriptions written by yourself, to a patient ≥ 65 years of age, that were dispensed by an outpatient pharmacy. We cannot tell if your patient took the antibiotic, only that it was dispensed to them. Your prescribing rate was adjusted for patient volume. Your peers were defined as other family physicians in Ontario that met the inclusion criteria.

Data were obtained from ICES (using a combination of OHIP billings and ODB drug claims). Physicians with the lowest prescribing quartile represent an achievable target for many family physicians in Ontario. As a society, we overuse antibiotics, particularly for respiratory tract infections. For context, in Sweden, physicians prescribe about half the number of antibiotics per population. Approximately one quarter of antibiotics prescribed by primary care physicians in Ontario are unnecessary. We encourage you to use the tools provided in this letter, as well as your data, to reflect on your antibiotic prescribing.

What is the evidence for shorter antibiotic durations? 

Numerous randomized controlled trials have been performed for common infectious diseases that have consistently showed that shorter courses of antibiotics are non-inferior to standard or longer courses. This does not mean that all patients can be treated with shorter durations and consideration should be given to the type of drug used, comorbidities and the patient’s response to therapy. Follow-up to ensure improvement and expected resolution is important. The studies have been nicely summarized at https://www.bradspellberg.com/shorter-is-better.

How do I get more information or opt out?

For questions about this report or to opt out of future reports in Ontario please complete this form: https://surveys.publichealthontario.ca/SE/245/FeedbackReportsOptOutForm/