Prescription Practices of Family Physicians in NLNCT03488121
Randomized Controlled Study to Incentivize Doctors for Appropriate Use of Medical Care in NL
A study testing Poster and Thank-you Letter in people with Prescription Practices of Family Physicians in NL, run by Memorial University of Newfoundland at 1 site in Canada.
Trial summary
Choosing Wisely Canada is a campaign for promoting appropriate use of medical services to reduce unnecessary prescribing and unnecessary diagnostic tests. Its success depends on physicians' uptake of the campaign's recommendations on appropriate use of health care. Read more about this study
- Who is it for?
- Any ageHealthy volunteers can take part
- Conditions the study is for
- Prescription Practices of Family Physicians in NL
- What is being tested?
- Poster and Thank-you Letter
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 0 participants
- Where
- 1 siteCanada
- Study dates
- 1 Sep 2018to 31 May 2020
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- Healthy volunteers accepted
- Child, Adult, Older adult
Who may be able to join
- All Fee-For-Service family physicians registered with the NL Medical Association
Who cannot join
- Salary based family physicians
Trial locations and contacts
1 site in 1 country.
Canada1 site
School of Pharmacy, Memorial University of Newfoundland
St. John's, Newfoundland and Labrador, A1B 3V6
About this study
Official title: When Less is More: A Real World Randomized Controlled Study to Incentivize Doctors for Appropriate Use of Medical Care in NL
Choosing Wisely Canada is a campaign for promoting appropriate use of medical services to reduce unnecessary prescribing and unnecessary diagnostic tests. Its success depends on physicians' uptake of the campaign's recommendations on appropriate use of health care. This study will conduct a cluster-randomized controlled trial to evaluate the effects of two low-cost incentives for physicians to promote their uptake of Choosing Wisely recommendations in Newfoundland and Labrador (NL). The first incentive involves placing a motivational poster in a physician's examination room. These posters will contain motivational messages about the important roles that doctors and patients can play in reducing unnecessary care. The second incentive involves sending thank-you letters to physicians to recognize their contribution in reducing unnecessary care, and thus, 'nudge' them into following recommendations. The study will evaluate the effects of the incentives on physicians' prescribing of antibiotics and serum ferritin tests. Potential cost savings of implementing the two incentives will also be estimated.
Read the detailed description
The study will employ a prospective, cluster randomized controlled trial design and will involve fee-for-service family physicians in NL. Randomization will be performed at the clinic level and stratified by clinic size. Clinics will be randomized into one of four groups: i) the control group will not receive any incentive; ii) the poster group will receive posters only; iii) the letter group will receive thank-you letters only; and iv) the double incentive group will receive both posters and thank-you letters. The number of clinics in each group will be equal.
The study will test two interventions. First, it will examine the impact of placing a poster in a physician's examination room containing motivational messages about the important roles that doctors and patients can play in reducing unnecessary care. The second incentive will involve sending thank-you letters to physicians aiming to encourage them to following Choosing Wisely's recommendations by recognizing their contribution in reducing unnecessary care. The study will focus on physicians' prescribing of antibiotics and serum ferritin tests. The posters will be designed to contain inspirational messages and pictures that highlight the important and unique roles that physicians and patients play in reducing unnecessary care and health care costs. These will be displayed in physicians' examination rooms so that they are salient to doctors and patients. The thank-you letters will contain two types of information: the changes in the rates of antibiotics and serum ferritin tests ordered since Choosing Wisely NL's introduction and a thank you message from the NL Medical Association (NLMA). These will be sent to doctors quarterly (to reinforce the message) with the changes in the rates of antibiotics and serum ferritin tests ordered being updated.
These incentives will be delivered over a 12-month period. The researchers will measure changes in the study outcomes at the end of this 12-month intervention period. Further, to examine if the effects of the intervention are sustained, these changes will be evaluated again 6 months after the withdrawal of incentives. The two incentives will be delivered via NLMA to its member family physicians. As such, physicians will be blinded to this study (i.e., they would not know that these posters and letters are part of a study). The study will focus on fee-for-service physicians in NL as data on the number of patients are only available for these physicians.
- Being tested
- Poster, Thank-you Letter
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
PosterBehavioural
Posters contain inspirational messages and pictures highlighting the important and unique roles that patients and physicians can play in reducing unnecessary care and health care costs. These posters will be placed in physician offices.
Thank-you LetterBehavioural
Physicians will be sent thank-you letters containing changes in the rates of antibiotics and serum ferritin tests ordered since introduction of Choosing Wisely NL and a thank-you message from the NL Medical Association.
| Study group | Role | What they receive |
|---|---|---|
| Poster Only | Experimental | This arm will only receive motivational posters. Receives: Behavioral: Poster |
| Thank-you Letter Only | Experimental | This arm will only receive thank-you letters. Receives: Behavioral: Thank-you Letter |
| Double Incentive | Experimental | This arm will receive both motivational posters and thank-you letters. Receives: Behavioral: Poster; Behavioral: Thank-you Letter |
| Control | No intervention | This arm will not receive any intervention. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Rate of antibiotic prescriptions
Rate of antibiotic prescriptions will be calculated as the number of antibiotic prescriptions per patient.
Measured: 12 months
Rate of ordering of serum ferritin tests
Rate of serum ferritin tests ordered will be calculated as the number of serum ferritin tests ordered per patient.
Measured: 12 months
Secondary outcomes (1)
Cost savings from implementing the incentives
Cost savings for 'Poster Only' arm: To estimate cost savings for this arm, reductions in prescription of antibiotics and serum ferritin tests in this arm (relative to control arm) estimated by the RCT will be converted into monetary values using pricing data from the literature.
Cost savings for 'Thank-you Letter Only' arm: To estimate cost savings for this arm, reductions in prescription of antibiotics and serum ferritin tests in this arm (relative to control arm) estimated by the RCT will be converted into monetary values using pricing data from the literature.
Cost savings for 'Double Incentive' arm: To estimate cost savings for this arm, reductions in prescription of antibiotics and serum ferritin tests in this arm (relative to control arm) estimated by the RCT will be converted into monetary values using pricing data from the literature.
Total cost savings will then be compared with total cost of implementing the associated incentive to estimate total net cost savings.
Measured: 12 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted4 Apr 2018
- Study start1 Sep 2018
- Primary completion31 May 2020 (estimated)
- Study completion31 May 2020 (estimated)
Why it stopped: The study was terminated due to logistical reasons
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Prescription Practices of Family Physicians in NLStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 0 participants (actual)
Sponsor and investigators
- Lead sponsor
- Memorial University of Newfoundland
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Hai Van Nguyen, Memorial University of Newfoundland
- Investigators
- Hai Nguyen, PhD, Principal investigator, Memorial University of Newfoundland
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03488121
- Sponsor's protocol ID
- 2017.282
- Status last verified
- Sep 2018
- First submitted
- 28 Mar 2018
- Last updated
- 10 Sep 2022
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 10 Sep 2022. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- When Less is More: A Real World Randomized Controlled Study to Incentivize Doctors for Appropriate Use of Medical Care in NL
- ClinicalTrials.gov ID
- NCT03488121
- Acronym / sponsor ID
- 2017.282
- Study type
- Interventional
- Recruitment status
- WithdrawnReason stopped: The study was terminated due to logistical reasons
- Enrolment
- 0 participants (actual)
- Lead sponsor
- Memorial University of NewfoundlandUniversity, hospital or other
- Study start
- 1 Sep 2018 (actual)
- Primary completion
- 31 May 2020 (estimated)
- Study completion
- 31 May 2020 (estimated)
- First posted
- 4 Apr 2018 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Choosing Wisely Canada is a campaign for promoting appropriate use of medical services to reduce unnecessary prescribing and unnecessary diagnostic tests. Its success depends on physicians' uptake of the campaign's recommendations on appropriate use of health care. This study will conduct a cluster-randomized controlled trial to evaluate the effects of two low-cost incentives for physicians to promote their uptake of Choosing Wisely recommendations in Newfoundland and Labrador (NL). The first incentive involves placing a motivational poster in a physician's examination room. These posters will contain motivational messages about the important roles that doctors and patients can play in reducing unnecessary care. The second incentive involves sending thank-you letters to physicians to recognize their contribution in reducing unnecessary care, and thus, 'nudge' them into following recommendations. The study will evaluate the effects of the incentives on physicians' prescribing of antibiotics and serum ferritin tests. Potential cost savings of implementing the two incentives will also be estimated.
Detailed description
The study will employ a prospective, cluster randomized controlled trial design and will involve fee-for-service family physicians in NL. Randomization will be performed at the clinic level and stratified by clinic size. Clinics will be randomized into one of four groups: i) the control group will not receive any incentive; ii) the poster group will receive posters only; iii) the letter group will receive thank-you letters only; and iv) the double incentive group will receive both posters and thank-you letters. The number of clinics in each group will be equal.
The study will test two interventions. First, it will examine the impact of placing a poster in a physician's examination room containing motivational messages about the important roles that doctors and patients can play in reducing unnecessary care. The second incentive will involve sending thank-you letters to physicians aiming to encourage them to following Choosing Wisely's recommendations by recognizing their contribution in reducing unnecessary care. The study will focus on physicians' prescribing of antibiotics and serum ferritin tests. The posters will be designed to contain inspirational messages and pictures that highlight the important and unique roles that physicians and patients play in reducing unnecessary care and health care costs. These will be displayed in physicians' examination rooms so that they are salient to doctors and patients. The thank-you letters will contain two types of information: the changes in the rates of antibiotics and serum ferritin tests ordered since Choosing Wisely NL's introduction and a thank you message from the NL Medical Association (NLMA). These will be sent to doctors quarterly (to reinforce the message) with the changes in the rates of antibiotics and serum ferritin tests ordered being updated.
These incentives will be delivered over a 12-month period. The researchers will measure changes in the study outcomes at the end of this 12-month intervention period. Further, to examine if the effects of the intervention are sustained, these changes will be evaluated again 6 months after the withdrawal of incentives. The two incentives will be delivered via NLMA to its member family physicians. As such, physicians will be blinded to this study (i.e., they would not know that these posters and letters are part of a study). The study will focus on fee-for-service physicians in NL as data on the number of patients are only available for these physicians.
Study design
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (participant)
- Number of arms
- 4
| Arm | Type | Receives |
|---|---|---|
| Poster Only | Experimental | Behavioral: PosterThis arm will only receive motivational posters. |
| Thank-you Letter Only | Experimental | Behavioral: Thank-you LetterThis arm will only receive thank-you letters. |
| Double Incentive | Experimental | Behavioral: Poster, Behavioral: Thank-you LetterThis arm will receive both motivational posters and thank-you letters. |
| Control | No intervention | –This arm will not receive any intervention. |
Who may qualify
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (1 listed)
- All Fee-For-Service family physicians registered with the NL Medical Association
Key exclusion criteria (1 listed)
- Salary based family physicians
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| PosterPosters contain inspirational messages and pictures highlighting the important and unique roles that patients and physicians can play in reducing unnecessary care and health care costs. These posters will be placed in physician offices. | Behavioural | Double Incentive, Poster Only |
| Thank-you LetterPhysicians will be sent thank-you letters containing changes in the rates of antibiotics and serum ferritin tests ordered since introduction of Choosing Wisely NL and a thank-you message from the NL Medical Association. | Behavioural | Double Incentive, Thank-you Letter Only |
Primary outcome
Rate of antibiotic prescriptions
Time frame: 12 months
Rate of antibiotic prescriptions will be calculated as the number of antibiotic prescriptions per patient.
Rate of ordering of serum ferritin tests
Time frame: 12 months
Rate of serum ferritin tests ordered will be calculated as the number of serum ferritin tests ordered per patient.
1 secondary outcome
Cost savings from implementing the incentives
Time frame: 12 months
Results and safety
The study was withdrawn before enrolling participants, so there are no results.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 10 Sep 2022.
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Hai Nguyen, PhD principal investigator
Memorial University of Newfoundland
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Poster and Thank-you Letter in people with Prescription Practices of Family Physicians in NL, run by Memorial University of Newfoundland at 1 site in Canada.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: withdrawn, as of the sponsor's last update on 10 Sep 2022. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study was withdrawn before enrolling participants, so there are no results.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Rate of antibiotic prescriptions (time frame: 12 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Sep 2022.