Table 1 Comparison of JPIAMR-PAAN’s 13 best practice recommendations on antibiotic audit and feedback interventions with Brehaut et al.’s 15 suggestions for practice feedback interventions

General considerations

1. Antibiotic audit and feedback interventions in primary care should be framed as quality improvement projects within a supportive environment

The specific framing of audit and feedback interventions was not considered in Brehaut’s original 15 suggestions

2. Prior to initiating an antibiotic audit and feedback intervention in primary care, consider potential barriers to success such as local data availability, data validity, expected engagement of feedback recipients, perceived patient expectations for antibiotics, and other situational factors

The Brehaut recommendations discuss potential barriers such as “prevent defensive reactions to feedback” – we discuss some potential barriers specific to antibiotic audit and feedback in primary care

3. Strategies to optimize reach and engagement of an antibiotic audit and feedback intervention in primary care include; utilizing an opt-out approach to delivery of feedback reports, offering of continuing medical education credits, financial incentives, and facilitated peer group discussions

The recommendation to “Address barriers to feedback use” is considered and we provide specific strategies to optimize engagement

Selecting feedback recipients

4. All primary care prescribers, regardless of practice type or prescribing volume, should be included in antibiotic prescribing audit and feedback interventions

Recommendation for the selection of feedback recipients was not provided

Data and indicator selection

5. Feedback indicators for antibiotic prescribing in primary care should target reductions in antibiotic initiations, prolonged antibiotic duration, and/or unnecessary broad-spectrum antibiotics

We built on the statement “Recommend actions that are consistent with established goals and priorities” and suggested specific indicators of high priority in antibiotic prescribing

6. Antibiotic feedback reports in primary care should enable and support behaviour change by providing guidance and educational resources

We agree with statements that “Recommend actions that can improve and are under the recipient’s control” and “Recommend specific actions”—such that we suggest antibiotic feedback reports to include specific action (e.g. reduce prescribing, prescribe for shorter duration) and evidence-based behaviour change messaging

7. The optimal data source for antibiotic audit and feedback in primary care is credible, valid, routinely collected, and comprehensive for the region; ideally containing prescription, diagnostic, and clinical data

No suggestion regarding the data sources for audits

8. Benchmarks or achievable targets for peer comparisons for antibiotic prescribing in primary care should be indicator specific and based on national and/or local performance data of high performing peers

We provide specific recommendations that support the statement “Choose comparators that reinforce desired behavior change” in the context of antibiotic prescribing

Feedback delivery

9. Antibiotic audit and feedback in primary care should be displayed such that recipients can understand their performance and desired actions within seconds

We concur with many of the suggestions related to feedback display and delivery, including “Closely link the visual display and summary message”, “Minimize extraneous cognitive load for feedback recipients”, and “Provide short, actionable messages followed by optional detail” – all three statements will apply in the context of primary care antibiotic audit and feedback

10. Antibiotic audit and feedback reports in primary care should be repeated with updated data over time. The optimal frequency is not known but can depend on local factors such as data availability and seasonality of prescribing

We agree with the suggestion to “Provide multiple instances of feedback”. However we recognize the difficulty with the suggestion “Provide feedback as soon as possible and at a frequency informed by the number of new patient cases” in the context of antibiotic prescribing, as well as the paucity of data on the optimal frequency of feedback

11. Antibiotic feedback in primary care should be ideally delivered by multiple strategies including verbal, paper, and/or electronic means

We further support the recommendation to “Provide feedback in more than one way”

12. Antibiotic feedback should be delivered to primary care prescribers from a respected authority figure or colleague

We believe that feedback delivery from a respective authority figure or colleagues is an effective way to “Address credibility of the information”

13. Individual-level antibiotic feedback should be delivered confidentially to primary care prescribers, and the opportunity for peer discussion should be provided and encouraged

Within the context of antibiotic prescribing, we stress the significance to “Provide individual rather than general data” given the nature of prescribing. Furthermore, we strongly encourage peer discussion of individual feedback with other prescribers, as a way to facilitate the suggestion “Construct feedback through social interaction”