Routine Antibiotic Prescription Monitoring in Primary Care Physicians: A Nationwide Trial
Routine Antibiotic Prescription Monitoring in Primary Care Physicians: A Nationwide Trial
Antibiotic resistance is an increasingly serious problem in Switzerland which is associated
 with the exposure and overall uptake of antibiotics in a population. Reduced antibiotic
 prescribing for outpatients is paralleled by a decrease in antibiotic resistance rates.

 In a recent pragmatic trial the investigators found only promising yet not very conclusive
 results as those were present only in some groups. This nationwide antibiotic stewardship
 program with routine feedback on antibiotic prescribing was not associated with an overall
 change of antibiotic use. In older children, adolescents, and younger adults less antibiotics
 were prescribed, but not consistently over the entire intervention period.

 Hence, the investigators now aim to evaluate a better tailored program to obtain a better
 understanding of the effects on patient-relevant outcomes, on antibiotic resistance, and of
 the underlying mechanisms leading to different effects in certain subgroups of patients.

 The investigators plan to evaluate a nationwide antibiotic stewardship program combining
 routine prescription feedback with the provision of physician and patient education material
 in primary care physician in Switzerland. The project is conducted within the framework of
 the National Program on antimicrobial resistance by the Swiss National Science Foundation.
This is a randomized pragmatic controlled trial in all primary care physicians in Switzerland
 e.g. the top 75% antibiotic prescribers. The trial is based on routinely collected individual
 reimbursement claims data of the three largest Swiss health insurers covering an estimated
 number of 3.8 million Swiss residents, and on routinely collected surveillance data on
 antibiotic resistance. A pragmatic trial design is used. Physicians in the intervention group
 will not have to provide informed consent but they may opt out and decline receiving any
 interventional information. Physicians in the control group will not be notified. This
 approach is justifiable and has previously been approved by all Swiss ethical committees.
 Investigators will take any measures to guarantee the confidentiality of all collected data.
 Data provided by health insurers on physicians and patients will be completely anonymized.

 This is a nationwide study enrolling all registered primary care physicians (general internal
 medicine and pediatrics) with more than 100 patient contacts in the year prior to the start
 of the trial. All primary care providers with shared ZSR (Zahlstellenregister) numbers (e.g.
 ambulatory settings in hospitals where individual physicians cannot be identified) and with
 less than 100 patient contacts per year will be excluded.
Inclusion Criteria:

 -  Primary care physicians in Switzerland board certified with FMH (Foederatio Medicorum
 Helveticorum) title in general internal medicine or paediatrics & adolescent medicine,
 above the 25th percentile of antibiotic prescribing, consulting with at least 100
 patients per year and with individual Zahlstellenregister number.

 Exclusion Criteria:

 -  There are no exclusion criteria