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IRCT20260611069750N1 IRCT 2026-07-15 Tehran University of Medical Sciences Evaluating the Effect of SMS-Based Feedback on Prescribing Indicators and Related Factors, and Explaining the Barriers and Facilitators Influencing Drug Prescribing Among General Practitioners in the Clinics of Tehran Province Evaluating the Effect of SMS-Based Feedback on Prescribing Indicators and Related Factors, and Explaining the Barriers and Facilitators Influencing Drug Prescribing Among General Practitioners in the Clinics of Tehran Province 2026-07-23 anticipated 645 Recruiting https://irct.ir/trial/91124 interventional Randomization: Randomized, Blinding: Not blinded, Placebo: Not used, Assignment: Parallel, Purpose: Health service research, Randomization description: The randomization method in this study is stratified randomization. The unit of randomization is the individual general practitioner, and allocation will be performed in a 1:1 ratio to the intervention and control groups. The randomization strata include the geographic area of practice based on the corresponding university of medical sciences and the physician’s clinic of practice. Within each stratum, the allocation sequence will be generated using statistical software and a computer-based random number generator. The randomization sequence will be prepared by a person independent of the intervention implementation, and the allocation list will be kept confidential until assignment. N/A Irrational drug prescribing with a focus on polypharmacy and antibiotic prescribing in outpatient care. Intervention 1: Intervention group: **The intervention in this study is SMS-based feedback on prescribing performance among general practitioners. Physicians in the intervention group will receive one feedback text message per month for three consecutive months from the Iran Health Insurance Organization. The content of each message will be prepared based on each physician’s electronic prescribing data from the previous month and will include the mean number of drug items per prescription, the percentage of prescriptions containing antibiotics, comparison with the provincial average and the World Health Organization benchmark of 20% for antibiotic prescribing, and a brief, respectful, non-punitive recommendation to improve rational drug prescribing.****In the first month, corrective feedback will be sent based on baseline prescribing performance. In the second and third months, the content of the message will be determined based on the physician’s prescribing performance in the previous month. If the indicators are higher than the reference values, a corrective comparative message will be sent; if the physician reaches the desirable level, an encouraging message will be sent. The control group will not receive any feedback text messages during the study period.**. Intervention 2: Control group: The control group will not receive any feedback text messages regarding their prescribing performance during the three-month study period. Physicians in this group will continue their usual prescribing practice, and no additional educational, feedback-based, or managerial intervention will be delivered by the research team. Electronic prescribing data for physicians in the control group will be extracted, similar to the intervention group, during the baseline period and throughout the study months to compare changes in prescribing indicators. Yes - There is a plan to make this available What will be shared: De-identified electronic prescribing data from the Iran Health Insurance Organization and coded qualitative interview files will be available after study completion. The final study protocol, including objectives, methods, intervention, outcomes, and statistical analysis, will be available for dissemination after finalization. The statistical analysis plan, including outcomes, variables, statistical models, and primary and secondary analyses, will be available after finalization. The final clinical study report, including methods, main results, interpretation of findings, and study conclusions, will be available after study completion. When: Data will be available after study completion and publication of results, for a limited period, subject to approval by the research team and the relevant organization. The protocol will be made available after final study registration and required approvals. The statistical analysis plan will be available after protocol finalization and before the final data analysis. The clinical study report will be available after completion of the study and finalization of the results. To whom: Qualified researchers for scientific purposes may access the data upon formal request and approval by the research team and the Iran Health Insurance Organization. Researchers, reviewers, and individuals with scientific or academic purposes may access the protocol upon approval by the principal investigator. Researchers, reviewers, and individuals with scientific purposes may access the statistical analysis plan upon approval by the principal investigator. Researchers, reviewers, and individuals with scientific or academic purposes may access the clinical study report upon approval by the principal investigator. Conditions: The data may be used only for scientific and research purposes, in de-identified form, after approval of the request and compliance with confidentiality requirements. The protocol may be used only for scientific, research, and academic dissemination purposes with proper citation of the source. This document may be used only for scientific, research, and methodological review purposes with proper citation of the source. The clinical study report may be used only for scientific, research, and educational purposes with proper citation of the source. Where to obtain: Applicants should submit their request to the principal investigator and, if required, to the Tehran Provincial Office of the Iran Health Insurance Organization. Applicants should contact the principal investigator to request access. Applicants should contact the principal investigator to request access. Applicants should contact the principal investigator to request access. How to obtain: After formal submission, the request will be reviewed for scientific purpose, confidentiality compliance, and approval by the principal investigator and the relevant organization; if approved, limited access will be granted. After submission, the request will be reviewed by the principal investigator, and if approved, the protocol will be provided. After review by the principal investigator, and if approved, the statistical analysis plan will be provided. After review by the principal investigator, and if approved, the clinical study report will be provided. Comments:
public Nezam Armand
Enqelab Street, Qods Street, Pour Sina Street, School of Public Health
Tehran Iran (Islamic Republic of) 1417613151 +98 21 2816 5607 armandnezam@gmail.com Tehran University of Medical Sciences scientific Nezam Armand
**Enqelab Street, Qods Street, Pour Sina Street, School of Public Health**
Tehran Iran (Islamic Republic of) 1417613151 +98 21 2816 5607 armandnezam@gmail.com Tehran University of Medical Sciences Iran (Islamic Republic of) The physician must be registered as a “general practitioner” in the Iran Health Insurance Organization electronic prescribing system. The physician must be working in clinics affiliated with the Iran Health Insurance Organization. The physician’s workplace must be located in one of the catchment areas of Tehran, Iran, or Shahid Beheshti Universities of Medical Sciences. The physician must have at least 30 recorded drug prescriptions during the baseline period. The physician must have at least one recorded prescription during the study year. The physician’s prescribing data must be retrievable and attributable to the physician in the system. A valid mobile phone number must be available for receiving feedback text messages. 26 years no limit Both The physician is simultaneously participating in another similar prescribing feedback program or intervention. No valid, usable mobile phone number is available to receive feedback text messages. The physician’s identifying or prescribing data are incomplete or inconsistent in a way that affects allocation or analysis. Prescriptions cannot be reliably attributed to the physician or to the clinic of practice. The physician has left the clinic setting before randomization. The physician is on prolonged leave, assignment, or absence during the study period in a way that affects prescribing activity. The physician has unreliable or outlier records caused by major system or registration errors. Behavior Behavior Intervention group: **The intervention in this study is SMS-based feedback on prescribing performance among general practitioners. Physicians in the intervention group will receive one feedback text message per month for three consecutive months from the Iran Health Insurance Organization. The content of each message will be prepared based on each physician’s electronic prescribing data from the previous month and will include the mean number of drug items per prescription, the percentage of prescriptions containing antibiotics, comparison with the provincial average and the World Health Organization benchmark of 20% for antibiotic prescribing, and a brief, respectful, non-punitive recommendation to improve rational drug prescribing.****In the first month, corrective feedback will be sent based on baseline prescribing performance. In the second and third months, the content of the message will be determined based on the physician’s prescribing performance in the previous month. If the indicators are higher than the reference values, a corrective comparative message will be sent; if the physician reaches the desirable level, an encouraging message will be sent. The control group will not receive any feedback text messages during the study period.** Control group: The control group will not receive any feedback text messages regarding their prescribing performance during the three-month study period. Physicians in this group will continue their usual prescribing practice, and no additional educational, feedback-based, or managerial intervention will be delivered by the research team. Electronic prescribing data for physicians in the control group will be extracted, similar to the intervention group, during the baseline period and throughout the study months to compare changes in prescribing indicators. Mean number of drug items per prescription. Timepoint: second half of the year before the intervention, and the post-intervention period in Azar, Dey, and Bahman. Method of measurement: These variables are measured at the physician level using data recorded in the Iran Health Insurance Organization electronic prescribing system. The mean number of drug items is calculated by dividing the total number of prescribed drug items by the total number of prescriptions. Percentage of prescriptions containing antibiotics. Timepoint: second half of the year before the intervention, and the post-intervention period in Azar, Dey, and Bahman. Method of measurement: These variables are measured at the physician level using data recorded in the Iran Health Insurance Organization electronic prescribing system. The percentage of prescriptions containing antibiotics is calculated by dividing the number of prescriptions containing at least one antibiotic by the total number of prescriptions and multiplying by 100. Tehran University of Medical Sciences Approved 2026-06-10 School of public health and allied medical sciences Tehran University of Medical Sciences School of Public Health, Tehran University of Medical Sciences, Enqelab Square, Tehran, Iran. Tehran Tehran Iran (Islamic Republic of)